Editorial
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2020; 11(4): 90-94
Published online Apr 15, 2020. doi: 10.4239/wjd.v11.i4.90
Hydrocortisone, ascorbic acid and thiamine for sepsis: Is the jury out?
Paul Ellis Marik, Joseph Varon, Salim R Surani
Paul Ellis Marik, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
Joseph Varon, Department of Critical Care, United Memorial Medical Service, Houston, TX 77030, United States
Salim R Surani, Texas A and M University, Corpus Christi, TX 78413, United States
Author contributions: All authors have contributed to the preparation of the manuscript, literature search and review of manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Paul Ellis Marik, FRCP (C), MBChB, MD, Chairman, Full Professor, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Av, Suite 410, Norfolk, VA 23507, United States. marikpe@evms.edu
Received: November 26, 2019
Peer-review started: November 26, 2019
First decision: December 23, 2019
Revised: December 24, 2019
Accepted: February 23, 2020
Article in press: February 23, 2020
Published online: April 15, 2020
Abstract

Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit. Diabetes is a major risk factor for the development of sepsis. The global mortality of sepsis remains high, despite significant interventions and guidelines. It has been known for decades that patients with sepsis have reduced levels of antioxidants, most notably vitamin C. Furthermore, experimental data has demonstrated multiple beneficial effects of vitamin C in sepsis. In addition, corticosteroids and thiamine may have synergistic biological effects together with vitamin C. Preliminary data suggests that therapy with hydrocortisone, ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of lives. However, this intervention has met with much resistance and has not been widely adopted. Ultimately, we await the final jury verdict on this simple, safe and cheap intervention.

Keywords: Diabetes, Vitamin C, Ascorbic acid, Sepsis, Thiamine, Septic shock, Global burden of disease

Core tip: The combination of ascorbic acid (vitamin C), hydrocortisone and thiamine hold great promise for the treatment of sepsis. Despite, significant evidence there remains reluctance among the medical community to adopt this intervention. hydrocortisone, ascorbic acid and thiamine have the potential for saving millions of lives. We await the final jury verdit on this simple, safe and cheap intervention.