Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis The ORANGES Trial
Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis The ORANGES Trial
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DOI：
10.1016/j.chest.2020.02.049
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发表时间：
2020-07-01
期刊：
影响因子：
9.6
通讯作者：
Elbaga, Yasmine
中科院分区：
文献类型：
--
作者：
Iglesias, Jose;Vassallo, Andrew V.;Elbaga, Yasmine
背景技术背景：脓毒症是一个主要的公共卫生负担，导致25%至30%的住院死亡率，并占超过20亿美元的美国医院costs.Research问题：氢化可的松，抗坏血酸，硫胺素（HAT）治疗改善脓毒症和脓毒性休克的临床结果？研究设计和方法：这是一项于2018年2月至2019年6月进行的随机、双盲、安慰剂对照试验，评估了HAT治疗包用于管理入住ICU的脓毒性和脓毒性休克患者。主要结局为休克消退和序贯器官衰竭评估（SOFA）评分的变化。次要结果包括28天死亡率，ICU死亡率，住院死亡率，降钙素原清除率（PCT-c），住院时间（LOS），ICU LOS，和无呼吸机days.Results：137例患者被随机分为治疗组（n = 68）和对照组（n = 69），分别与基线特征没有显着差异。患者需要血管加压药的时间存在统计学显著差异，表明HAT组与对照组相比休克逆转更快（27 +/- 22 vs 53 +/- 38小时，P
BACKGROUND: Sepsis is a major public health burden resulting in 25% to 30% in-hospital mortality and accounting for over 20 billion dollars of US hospital costs.RESEARCH QUESTION: Does hydrocortisone, ascorbic acid, thiamine (HAT) therapy improve clinical outcomes in sepsis and septic shock?STUDY DESIGN AND METHODS: This was a randomized, double-blinded, placebo-controlled trial conducted from February 2018 to June 2019, assessing an HAT treatment bundle for the management of septic and septic shock patients admitted to an ICU. The primary outcomes were resolution of shock and change in Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included 28-day mortality, ICU mortality, hospital mortality, procalcitonin clearance (PCT-c), hospital length of stay (LOS), ICU LOS, and ventilator-free days.RESULTS: One hundred thirty-seven patients were randomized to the treatment group (n = 68) and comparator group (n = 69), respectively, with no significant differences in baseline characteristics. A statistically significant difference was found in the time patients required vasopressors, indicating quicker reversal of shock in the HAT group compared with the comparator group (27 +/- 22 vs 53 +/- 38 hours, P