Division of Critical Care Medicine, Montefiore Medical Center, The Bronx, New York.
Bronx Center for Critical Care Outcomes and Resuscitation Research, The Bronx, New York.
Am J Respir Crit Care Med. 2023 Sep 1;208(5):570-578. doi: 10.1164/rccm.202301-0034OC.
Kidney injury is common and associated with worse outcomes in patients with septic shock. Mitochondrial resuscitation with thiamine (vitamin B1) may attenuate septic kidney injury. To assess whether thiamine supplementation attenuates kidney injury in septic shock. The TRPSS (Thiamine for Renal Protection in Septic Shock) trial was a multicenter, randomized, placebo-controlled trial of thiamine versus placebo in septic shock. The primary outcome was change in serum creatinine between enrollment and 72 hours after enrollment. Eighty-eight patients were enrolled (42 patients received the intervention, and 46 received placebo). There was no significant between-groups difference in creatinine at 72 hours (mean difference, -0.57 mg/dl; 95% confidence interval, -1.18, 0.04; = 0.07). There was no difference in receipt of kidney replacement therapy (14.3% vs. 21.7%, = 0.34), acute kidney injury (as defined by stage 3 of the Kidney Disease: Improving Global Outcomes acute kidney injury scale; 54.7% vs. 73.9%, = 0.07), or mortality (35.7% vs. 54.3%, = 0.14) between the thiamine and placebo groups. Patients who received thiamine had more ICU-free days (median [interquartile range]: 22.5 [0.0-25.0] vs. 0.0 [0.0-23.0], < 0.01). In the thiamine-deficient cohort (27.4% of patients), there was no difference in rates of kidney failure (57.1% thiamine vs. 81.5% placebo) or in-hospital mortality (28.6% vs. 68.8%) between groups. In the TRPSS trial, there was no statistically significant difference in the primary outcome of change in creatinine over time. Patients who received thiamine had more ICU-free days, but there was no difference in other secondary outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT03550794).
肾脏损伤在脓毒症性休克患者中较为常见，且与较差的预后相关。使用硫胺素（维生素 B1）进行线粒体复苏可能减轻脓毒症性肾损伤。评估硫胺素补充是否可减轻脓毒性休克中的肾损伤。TRPSS（脓毒症性休克中硫胺素的肾脏保护作用）试验是一项多中心、随机、安慰剂对照的硫胺素与安慰剂治疗脓毒性休克的试验。主要结局为入组至入组后 72 小时之间血清肌酐的变化。共纳入 88 例患者（42 例接受干预，46 例接受安慰剂）。72 小时时两组间肌酐无显著差异（平均差值，-0.57mg/dl；95%置信区间，-1.18，0.04； = 0.07）。接受肾脏替代治疗的患者比例无差异（14.3%比 21.7%， = 0.34），急性肾损伤（按改善全球肾脏病预后组织急性肾损伤分期 3 期定义；54.7%比 73.9%， = 0.07），或死亡率（35.7%比 54.3%， = 0.14）在硫胺素组和安慰剂组之间也无差异。接受硫胺素的患者 ICU 无天数更多（中位数[四分位数间距]：22.5[0.0-25.0]比 0.0[0.0-23.0]， < 0.01）。在硫胺素缺乏队列（27.4%的患者）中，两组间肾功能衰竭发生率（硫胺素组 57.1%比安慰剂组 81.5%）或院内死亡率（硫胺素组 28.6%比安慰剂组 68.8%）无差异。TRPSS 试验中，主要结局血清肌酐随时间的变化无统计学差异。接受硫胺素的患者 ICU 无天数更多，但其他次要结局无差异。临床试验注册于 www.clinicaltrials.gov（NCT03550794）。
