HYVCTTSSS RCT – Vit C, Thiamine, Hydrocortisone Cocktail

May 6, 2020

Spoon Feed
A combination of hydrocortisone, thiamine, and vitamin C for sepsis patients did not improve 28-day mortality.

Why does this matter?
We have discussed sepsis cocktails before. CITRUS-ALI found no difference with high-dose vitamin C in SOFA score or inflammatory marker levels, but they did find a secondary outcome of lower 28-day mortality. VITAMINS was also a negative study. What does this RCT show?

HYVCTTSSS – what even is that and why could they not come up with a better name?
This was an 80 person single-blinded RCT in patients with sepsis or septic shock comparing: “hydrocortisone (50 mg every 6 h for 7 days), vitamin C (1.5 g every 6 h for 4 days), and thiamine (200 mg every 12 h for 4 days) vs placebo (normal saline).” There was no difference in the primary outcome of 28-day mortality: 27.5% vs 35%; RR 0.79 (95%CI 0.41 to 1.52). SOFA score at 72 hours was lower in the cocktail group. Interesting, and hypothesis-generating, in the group with a sepsis diagnosis within 48 hours of onset, mortality was lower. Maybe giving the cocktail earlier is better. Severe hypernatremia (>160meq/L) was more common in the treatment group, 13 vs. 3 in the control (p=0.005), leading to early termination of the study.

Source
Combined treatment with hydrocortisone, vitamin C, and thiamine for sepsis and septic shock (HYVCTTSSS): A randomized controlled clinical trial. Chest. 2020 Mar 31. pii: S0012-3692(20)30552-3. doi: 10.1016/j.chest.2020.02.065. [Epub ahead of print]

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