Literature Review of the Combination Hydrocortisone, Ascorbic Acid, and Thiamine (HAT) Therapy in Reducing Mortality in Critically Ill Patients with Sepsis or Septic Shock
by Charina A. Ruiz, PharmD
"Sepsis is a life-threatening illness characterized by a dysregulated host response to infection contributing to one-third to one-half of all hospital deaths as well as more than 5 million deaths annually worldwide. The current management of sepsis and septic shock include administration of intravenous fluids, vasoactive medications, and broad-spectrum antibiotics. High dose ascorbic acid has been recently explored as adjunctive therapy in sepsis due to its anti-inflammatory and antioxidant properties. Effects of ascorbic acid include reduction of endothelial permeability, improvement of microvascular and macrovascular function, and reduction of inflammatory mediators. Thiamine deficiency exists in about 20% of patients with sepsis and may be associated with an increased risk of mortality. In patients with a critical illness, thiamine stores are depleted so supplementation with thiamine may improve organ function. Hydrocortisone is effective in resolving septic shock and current clinical practice guidelines recommend hydrocortisone in patients with septic shock who are not responding adequately to fluid resuscitation and vasopressors. The rationale for including hydrocortisone in HAT therapy is based on the potential synergistic effects with ascorbic acid. Because of the high mortality risk associated with sepsis, it has been a global public health priority to explore new treatment options for patients with sepsis and septic shock. The combination of hydrocortisone, ascorbic acid, and thiamine (HAT) is emerging as a potential adjunct treatment option in patients with sepsis and septic shock."
Keywords: Humans, Shock, Septic, Antioxidants, Hydrocortisone, Thiamine, Ascorbic Acid, Critical Illness, Anti-Bacterial Agents, Health Priorities, Beriberi, Thiamine Deficiency, Sepsis, Anti-Inflammatory Agents, Permeability, Inflammation Mediators, Dietary Supplements
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2020 September/October Table of Contents
"Sepsis is a life-threatening illness characterized by a dysregulated host response to infection contributing to one-third to one-half of all hospital deaths as well as more than 5 million deaths annually worldwide. The current management of sepsis and septic shock include administration of intravenous fluids, vasoactive medications, and broad-spectrum antibiotics. High dose ascorbic acid has been recently explored as adjunctive therapy in sepsis due to its anti-inflammatory and antioxidant properties. Effects of ascorbic acid include reduction of endothelial permeability, improvement of microvascular and macrovascular function, and reduction of inflammatory mediators. Thiamine deficiency exists in about 20% of patients with sepsis and may be associated with an increased risk of mortality. In patients with a critical illness, thiamine stores are depleted so supplementation with thiamine may improve organ function. Hydrocortisone is effective in resolving septic shock and current clinical practice guidelines recommend hydrocortisone in patients with septic shock who are not responding adequately to fluid resuscitation and vasopressors. The rationale for including hydrocortisone in HAT therapy is based on the potential synergistic effects with ascorbic acid. Because of the high mortality risk associated with sepsis, it has been a global public health priority to explore new treatment options for patients with sepsis and septic shock. The combination of hydrocortisone, ascorbic acid, and thiamine (HAT) is emerging as a potential adjunct treatment option in patients with sepsis and septic shock."
Keywords: Humans, Shock, Septic, Antioxidants, Hydrocortisone, Thiamine, Ascorbic Acid, Critical Illness, Anti-Bacterial Agents, Health Priorities, Beriberi, Thiamine Deficiency, Sepsis, Anti-Inflammatory Agents, Permeability, Inflammation Mediators, Dietary Supplements
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2020 September/October Table of Contents