Vitamin and steroid treatment for sepsis fails in major study

By Brian Ward

Read today's articles

Despite earlier hopes, a major study has found that infusions of vitamin C, vitamin B1, and steroids are ineffective at treating sepsis. Proponents of the treatment say the study is flawed and plan to keep using vitamin C on sepsis patients.

 Sepsis is the leading cause of death in hospital patients and causes 270,000 deaths annually in the U.S. and 11 million globally.

Currently, the only treatment option for sepsis is an aggressive regimen of antibiotics. However, this is only partially effective, and even an hour delay in antibiotics increases the odds of mortality by 10%. Then news broke in 2017 of promising results coming out of Norfolk, VA.  Paul Marik, MD, FCCP, FCCM, released results showing that mortality rates in his sepsis patients dropped precipitously when given vitamin C infusions. Many hoped this could mean a cheap and simple cure for sepsis had been discovered, and a several large-scale studies have underway. Many facilities haven’t waited, opting to use vitamin C on patients immediately.

"People latch on to promising interventions because of that frustration," study leader Dr. Rinaldo Bellomo of Austin Hospital and Monash University in Melbourne, Australia, told NPR. "And it's understandable. But, you know, the view from here is that we shouldn't substitute hope for evidence."

Bellomo’s study involved more than 200 patients in Australia, Brazil, and New Zealand with the results published in the Journal of the American Medical Association.

Craig Coopersmith, MD, interim director of the Emory Critical Care Center at Emory University, told NPR the study was “discouraging,” but that doesn’t mean the treatment is useless. While the study found no effect on short-term survival or improvement in certain clinical markers from vitamin C, he said, it could have a modest effect on overall survival rates. The study didn’t have enough patients to answer that question.

"I don't think we can yet say that there is no impact," Coopersmith said. "I think we could say that the jury's still out on that."

Marik rejects the findings of the study and claimed that the treatment was given to test patients after their disease had progressed too far to have an effect. Marik noted that to be effective, the treatment needs to be given within six hours of the physician seeing sepsis symptoms. However, due to the controlled nature of the study, researchers didn’t start treatment until 12 hours after patients arrived at the ICU on average.

"It's like giving it to a patient who's dead," Marik told NPR. "It's of no benefit. The horse was out of the barn miles beforehand."

"The question is, why does this study not replicate real-life experience and the experience of hundreds of clinicians around the world?" he added.

More studies are being conducted on vitamin C and sepsis.