Yoshihisa Miyamoto1, Shotaro Aso2, Masao Iwagami3,4, Hideo Yasunaga2, Hiroki Matsui2, Kiyohide Fushimi5, Yoshifumi Hamasaki1,6, Masaomi Nangaku1,6, Kent Doi7. 1. Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. 2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. 3. Health Services Research and Development Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 4. Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan. 5. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan. 6. Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan. 7. Department of Acute Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
Abstract
OBJECTIVES: To examine the effect of thiamine administration on mortality in patients with septic shock requiring norepinephrine. DESIGN: Retrospective observational cohort study from July 2010 to March 2017. SETTING: More than 1,000 acute care hospitals covering approximately 90% of all tertiary care emergency hospitals in Japan. PATIENTS: Patients with septic shock requiring norepinephrine within 2 days of admission were retrospectively reviewed. INTERVENTIONS: Patients who received greater than or equal to 100 mg of thiamine within 2 days of admission were included in the thiamine group and those who did not were included in the control group. MEASUREMENTS AND MAIN RESULTS: We identified a total of 68,571 eligible patients, including 18,780 and 49,791 patients in the thiamine and control groups, respectively. In the thiamine group, 100 and 200 mg of thiamine per day were administered to 10,143 (54.0%) and 7,679 (40.9%) patients, respectively. The 28-day mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791) in the thiamine and control groups, respectively. After adjusting for confounders by inverse probability of treatment weighting, no significant differences were observed between the two groups (risk difference, 0.2%; 95% CI, -0.5% to 0.9%). There were also no significant differences between the 100-mg thiamine group and the control group (risk difference, 0.6%; 95% CI, -0.3% to 1.4%) or between the 200-mg thiamine group and the control group (risk difference, -0.3%; 95% CI, -1.3% to 0.8%). CONCLUSIONS: The findings of this nationwide database-based observational study did not support an association between thiamine administration early after admission and the 28-day mortality in patients with septic shock.
OBJECTIVES: To examine the effect of thiamine administration on mortality in patients with septic shock requiring norepinephrine. DESIGN: Retrospective observational cohort study from July 2010 to March 2017. SETTING: More than 1,000 acute care hospitals covering approximately 90% of all tertiary care emergency hospitals in Japan. PATIENTS: Patients with septic shock requiring norepinephrine within 2 days of admission were retrospectively reviewed. INTERVENTIONS:Patients who received greater than or equal to 100 mg of thiamine within 2 days of admission were included in the thiamine group and those who did not were included in the control group. MEASUREMENTS AND MAIN RESULTS: We identified a total of 68,571 eligible patients, including 18,780 and 49,791 patients in the thiamine and control groups, respectively. In the thiamine group, 100 and 200 mg of thiamine per day were administered to 10,143 (54.0%) and 7,679 (40.9%) patients, respectively. The 28-day mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791) in the thiamine and control groups, respectively. After adjusting for confounders by inverse probability of treatment weighting, no significant differences were observed between the two groups (risk difference, 0.2%; 95% CI, -0.5% to 0.9%). There were also no significant differences between the 100-mg thiamine group and the control group (risk difference, 0.6%; 95% CI, -0.3% to 1.4%) or between the 200-mg thiamine group and the control group (risk difference, -0.3%; 95% CI, -1.3% to 0.8%). CONCLUSIONS: The findings of this nationwide database-based observational study did not support an association between thiamine administration early after admission and the 28-day mortality in patients with septic shock.
Authors: Sung Yeon Hwang; Seung Mok Ryoo; Jong Eun Park; You Hwan Jo; Dong-Hyun Jang; Gil Joon Suh; Taegyun Kim; Youn-Jung Kim; Seonwoo Kim; Hyun Cho; Ik Joon Jo; Sung Phil Chung; Sung-Hyuk Choi; Tae Gun Shin; Won Young Kim Journal: Intensive Care Med Date: 2020-08-11 Impact factor: 17.440