Emily A Vail1, Hannah Wunsch2, Ruxandra Pinto2, Nicholas A Bosch3, Allan J Walkey3, Peter K Lindenauer4, Hayley B Gershengorn5,6. 1. Department of Anesthesiology, University of Texas Health San Antonio, San Antonio, Texas. 2. Department of Anesthesiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University, Boston, Massachusetts. 4. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts. 5. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida; and. 6. Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York.
Abstract
Rationale: In December 2016, a single-center study describing significant improvements in mortality among a small group of patients with severe sepsis and septic shock treated with hydrocortisone, high-dose ascorbic acid, and thiamine (HAT therapy) was published online. Objectives: This study aims to describe the administration of HAT therapy among U.S. adults with septic shock before and after study publication and to compare outcomes between patients who received and did not receive HAT therapy. Methods: We performed a retrospective cohort study of 379 acute care hospitals in the Premier Healthcare Database including patients discharged from October 1, 2015, to September 30, 2018. Exposure was quarter year of hospital discharge; postpublication was defined as January 2017 onward (July 2017 for effectiveness analyses). The primary outcome was receipt of HAT at least once during hospitalization. We conducted unadjusted segmented regression analyses to examine temporal trends in HAT administration. In patients with early septic shock, we compared the association of early HAT therapy (within 2 d of hospitalization) with hospital mortality using multivariable modeling and propensity score matching.Measurements and Main Results: Among 338,597 patients, 3,574 (1.1%) received HAT therapy, 98.7% in the postpublication period. HAT administration increased from 0.03% of patients (95% confidence interval [CI], 0.02-0.04) before publication to 2.65% (95% CI, 2.46-2.83) in the last quarter, with a significant step up in use after December 2016 (P < 0.001). Receipt of early HAT was associated with higher hospital mortality (28.2% vs. 19.7%; P < 0.001; adjusted odds ratio, 1.17 [95% CI, 1.02-1.33]; primary propensity-matched model adjusted odds ratio, 1.19 [95% CI, 1.02-1.40]).Conclusions: Publication of a single-center retrospective study was associated with significantly increased administration of HAT. Among patients with early septic shock, receipt of HAT was not associated with mortality benefit.
Rationale: In December 2016, a single-center study describing significant improvements in mortality among a small group of patients with severe sepsis and septic shock treated with hydrocortisone, high-dose ascorbic acid, and thiamine (HAT therapy) was published online. Objectives: This study aims to describe the administration of HAT therapy among U.S. adults with septic shock before and after study publication and to compare outcomes between patients who received and did not receive HAT therapy. Methods: We performed a retrospective cohort study of 379 acute care hospitals in the Premier Healthcare Database including patients discharged from October 1, 2015, to September 30, 2018. Exposure was quarter year of hospital discharge; postpublication was defined as January 2017 onward (July 2017 for effectiveness analyses). The primary outcome was receipt of HAT at least once during hospitalization. We conducted unadjusted segmented regression analyses to examine temporal trends in HAT administration. In patients with early septic shock, we compared the association of early HAT therapy (within 2 d of hospitalization) with hospital mortality using multivariable modeling and propensity score matching.Measurements and Main Results: Among 338,597 patients, 3,574 (1.1%) received HAT therapy, 98.7% in the postpublication period. HAT administration increased from 0.03% of patients (95% confidence interval [CI], 0.02-0.04) before publication to 2.65% (95% CI, 2.46-2.83) in the last quarter, with a significant step up in use after December 2016 (P < 0.001). Receipt of early HAT was associated with higher hospital mortality (28.2% vs. 19.7%; P < 0.001; adjusted odds ratio, 1.17 [95% CI, 1.02-1.33]; primary propensity-matched model adjusted odds ratio, 1.19 [95% CI, 1.02-1.40]).Conclusions: Publication of a single-center retrospective study was associated with significantly increased administration of HAT. Among patients with early septic shock, receipt of HAT was not associated with mortality benefit.
Entities:
Keywords:
ascorbic acid; critical care; physicians’ practice patterns; septic shock
Authors: Robinder G Khemani; Jessica T Lee; David Wu; Edward J Schenck; Margaret M Hayes; Patricia A Kritek; Gökhan M Mutlu; Hayley B Gershengorn; Rémi Coudroy Journal: Am J Respir Crit Care Med Date: 2021-05-01 Impact factor: 21.405
Authors: Yiorgos Alexandros Cavayas; Alexandre Noël; Veronique Brunette; David Williamson; Anne Julie Frenette; Christine Arsenault; Patrick Bellemare; Colin Lagrenade-Verdant; Soazig LeGuillan; Emilie Levesque; Yoan Lamarche; Marc Giasson; Philippe Rico; Yanick Beaulieu; Pierre Marsolais; Karim Serri; Francis Bernard; Martin Albert Journal: Can J Anaesth Date: 2020-09-15 Impact factor: 6.713