Introduction/Hypothesis: The combination of parenteral hydrocortisone, ascorbic acid and thiamine (HAT) has been proposed as a metabolic support therapy in septic shock patients. This study was conducted to determine whether HAT therapy was associated with reduced mortality in children with septic shock.
Methods: Single-center, propensity score-matched cohort study of children with septic shock admitted to a large, urban, academic pediatric intensive care unit (PICU) between January 2014 and February 2019. Septic shock was defined as those admitted with a suspected or confirmed infection who required vasoactive infusions for the treatment of shock. Patients were divided into three groups: HAT therapy patients, hydrocortisone only patients, and untreated control patients. HAT therapy was available as an adjunctive therapy starting May 2017. Hydrocortisone only was available throughout the study period. Patients were matched based on the propensity to use HAT therapy using the following variables: age, immunocompromised state, the presence of multiple complex chronic conditions and the following variables in the first 24 hours of admission to the PICU: peak vasoactive inotrope score, peak serum lactate level, need for mechanical ventilation, and lowest PaO2/FiO2 ratio.
Results: 557 patients met septic shock criteria during the study period. 43 patients (8%) received HAT therapy, 181 (32%) received hydrocortisone only therapy, and 333 (60%) did not receive either adjunctive therapy. The 43 patients who received HAT therapy were matched 1:1 with 43 untreated controls and 43 hydrocortisone only patients. Patients who received HAT therapy had lower mortality than matched untreated controls at 30 days (9% vs. 28%, p=0.03) and 90 days (14% vs. 35%, p=0.02). When compared with matched hydrocortisone only patients, those who received HAT therapy had lower mortality at both 30 days (9% vs 28%, p=0.03) and 90 days (14% vs 33%, p=0.04). There were no differences in vasoactive inotrope-free days or hospital-free days at 30 days in either of the two comparisons.
Conclusions: Our results suggest that HAT therapy, when administered early in the clinical course, reduces mortality in children with septic shock. Further multi-center, prospective studies are needed to confirm these findings.