Idahor Courage O, Ogunfuwa Olamide, Ogbonna Ndidiamaka, Adigwe Augustina, Ogbeide Omo A
Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham, GBR.
Emergency Medicine, Sandwell and West Birmingham NHS Trust, Birmingham, GBR.
Cureus. 2025 May 23;17(5):e84666. doi: 10.7759/cureus.84666. eCollection 2025 May.
Sepsis remains a major contributor to mortality among critically ill patients, with sepsis-induced metabolic dysfunction significantly worsening outcomes. As metabolic dysfunction plays a key role in the pathogenesis of sepsis, recent interest has grown around metabolic resuscitation therapies as potential adjuncts to traditional fluid resuscitation strategies. This narrative review evaluates current evidence regarding the role of vitamin C, thiamine, and corticosteroids in improving sepsis outcomes. Early studies suggested that vitamin C may reduce organ dysfunction and vasopressor requirements; however, more recent randomized trials have produced inconsistent results, with some findings even indicating potential harm in certain patient groups. Similarly, the use of corticosteroids in sepsis management has shown mixed outcomes. Thiamine has demonstrated possible renal protective effects and improved lactate clearance, although its impact on mortality and vasopressor needs remains inconclusive. Combination therapy with hydrocortisone, vitamin C, and thiamine (the HAT protocol) has been associated with reduced vasopressor duration but has not consistently improved survival or other major clinical endpoints, despite its apparent safety. Overall, while vitamin C, corticosteroids, and thiamine present a theoretically attractive strategy in sepsis management, clinical results remain debated. Corticosteroids currently have the strongest supporting evidence for use in septic shock, while vitamin C and thiamine remain investigational therapies and are not recommended for routine use outside clinical trials. Future research should explore biomarker-guided, precision-medicine approaches to better identify patients who might benefit most from metabolic resuscitation, and large-scale randomized controlled trials are needed to clarify optimal timing and dosing strategies.
脓毒症仍然是危重症患者死亡的主要原因,脓毒症诱导的代谢功能障碍会显著恶化预后。由于代谢功能障碍在脓毒症发病机制中起关键作用,近年来,作为传统液体复苏策略的潜在辅助手段,代谢复苏疗法受到了越来越多的关注。本叙述性综述评估了关于维生素C、硫胺素和皮质类固醇在改善脓毒症预后方面作用的现有证据。早期研究表明,维生素C可能减少器官功能障碍并降低血管活性药物的需求;然而,最近的随机试验结果并不一致,一些研究结果甚至表明在某些患者群体中可能存在潜在危害。同样,在脓毒症治疗中使用皮质类固醇的结果也喜忧参半。硫胺素已显示出可能的肾脏保护作用并改善了乳酸清除率,但其对死亡率和血管活性药物需求的影响仍不确定。氢化可的松、维生素C和硫胺素联合治疗方案(HAT方案)与血管活性药物使用时间缩短有关,尽管其安全性良好,但并未持续改善生存率或其他主要临床终点。总体而言,虽然维生素C、皮质类固醇和硫胺素在脓毒症治疗中提出了一种理论上有吸引力的策略,但临床结果仍存在争议。目前,皮质类固醇在感染性休克治疗中的使用证据最为充分,而维生素C和硫胺素仍为试验性治疗方法,不建议在临床试验之外常规使用。未来的研究应探索基于生物标志物的精准医学方法,以更好地识别可能从代谢复苏中获益最大的患者,并且需要大规模随机对照试验来阐明最佳时机和给药策略。
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