Thiamine in septic shock patients with alcohol abuse

摘要 酒精使用障碍(AUD)与发病率的增加和预后的恶化有关 在败血症中。硫胺素(维生素B1)缺乏在AUDS患者中很常见，并可能导致毁灭性的 后遗症，包括神经、代谢和心血管并发症。欧洲指南建议 静脉注射硫胺素预防已知AUDS住院患者的神经系统并发症 然而，很少有人关注心血管并发症或死亡的可能性。缺乏客观数据 至于AUDS和脓毒症患者在没有硫胺素供应的情况下死亡风险是否增加。在……里面 在目前的提案中，我们试图描述围绕硫胺素给药的实践模式 感染性休克并伴有AUD的专利。此外，我们假设患有AUDS的败血症患者 与静脉注射硫胺素的患者相比，不接受静脉注射硫胺素的患者的住院死亡率会增加 注射硫胺素。我们用以下初步数据来支持这一点：1)AUDS患者众所周知 有硫胺素缺乏症，2)硫胺素缺乏症患者严重威胁生命 对硫胺素快速反应的酸中毒，3)单中心数据显示败血症的数量惊人地高 未接受硫胺素治疗的AUDS休克患者，4)脓毒症患者硫胺素缺乏症发生率高 与AUDS无关的休克患者，以及5)一项前瞻性随机试验表明，给予 硫胺素可降低败血症和硫胺素缺乏症患者的死亡率。在本研究中，我们将利用 包含来自全美480多家医疗保健机构的信息的大型数据注册表。 具体地说，我们将调查AUD患者进入重症监护病房的比例。 感染性休克，接受/不接受硫胺素治疗。此外，接受硫胺素治疗的患者的临床结果 将与没有服用硫胺素的人进行比较，使用基于时间依赖倾向的分析 风险集匹配。如果我们的假设被证明是正确的，我们预计这项研究将导致 脓毒症合并AUDS患者的治疗，更多地关注早期硫胺素的应用。作为AUD 在败血症人群中很常见，并且有效地替代了硫胺素缺乏，显示出改善 硫胺素注射的结果可能会促使硫胺素广泛应用于较大的脓毒症 人口。最后，AUD脓毒症患者中未经治疗的硫胺素缺乏的流行病学及其 对医院结果的潜在影响是一个尚未探索的研究途径。

Abstract Alcohol use disorders (AUDs) have been associated with both an increased incidence and worsened outcomes in sepsis. Thiamine (Vitamin B1) deficiency is common in patients with AUDs and can lead to devastating sequela, including neurological, metabolic, and cardiovascular complications. European guidelines recommend parenteral thiamine for the prevention of neurologic complications in hospitalized patients with known AUDs, however there is little focus on cardiovascular complications or the potential for death. Objective data is lacking as to whether patients with AUDs and sepsis are at increased risk of death without the provision of thiamine. In the present proposal, we seek to characterize practice patterns surrounding thiamine administration amongst patents with septic shock and concomitant AUD. Moreover, we hypothesize that septic patients with AUDs who do not receive intravenous thiamine will have increased hospital mortality when compared with patients who do receive thiamine. We support this with the following preliminary data: 1) Patients with AUDs are well-known to have thiamine deficiency, 2) Patients with thiamine deficiency disorders develop profound life-threatening acidosis that is rapidly responsive to thiamine, 3) Single-center data shows a surprisingly high number of septic shock patients with AUDs not receiving thiamine, 4) There is a high incidence of thiamine deficiency in septic shock patients independent of AUDs, and 5) A prospective randomized trial illustrated that the administration of thiamine reduces mortality in patients with sepsis and thiamine deficiency. For this study, we will leverage a large data registry containing information from over 480 health-care facilities across the Unites States. Specifically, we will investigate the proportion of patients with AUD who are admitted to the intensive care unit with septic shock and do/do not receive thiamine. Further, clinical outcomes in patients who received thiamine will be compared to those who did not receive thiamine, using a time-dependent propensity based analysis with risk set matching. If our hypotheses are proven true, we anticipate that this study will lead to a shift in management of septic patients with AUDs with an increased focus on early thiamine administration. As AUDs are common in septic populations and are effectively a proxy for thiamine deficiency, demonstrating improved outcomes from thiamine administration may spark the widespread provision of thiamine to the larger septic population. Finally, the epidemiology of untreated thiamine deficiency amongst septic patients with AUD and its potential effects on hospital outcomes represents an unexplored avenue of investigation.