TY - JOUR
T1 - Thiamine in septic shock patients with alcohol use disorders
T2 - An observational pilot study
AU - Holmberg, Mathias Johan
AU - Moskowitz, Ari
AU - Patel, Parth Vijay
AU - Grossestreuer, Anne Victoria
AU - Uber, Amy
AU - Stankovic, Nikola
AU - Andersen, Lars Wiuff
AU - Donnino, Michael William
N1 - Funding Information:
Dr. Donnino is supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K24HL127101. Dr. Moskowitz is supported by the National Institute of Health (2T32HL007374-37). None of the funding sources were involved in the design of the study, data collection, analysis, writing or submission of this paper.
Funding Information:
Dr. Donnino is supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K24HL127101 . Dr. Moskowitz is supported by the National Institute of Health ( 2T32HL007374-37 ). None of the funding sources were involved in the design of the study, data collection, analysis, writing or submission of this paper.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Purpose Alcohol-use disorders (AUDs) have been associated with increased sepsis-related mortality. As patients with AUDs are often thiamine deficient, we investigated practice patterns relating to thiamine administration in patients with AUDs presenting with septic shock and explored the association between receipt of thiamine and mortality. Materials We performed a retrospective cohort study of patients presenting with septic shock between 2008 and 2014 at a single tertiary care center. We identified patients with an AUD diagnosis, orders for microbial cultures and use of antibiotics, vasopressor dependency, and lactate levels ≥ 4 mmol/L. We excluded those who received thiamine later than 48 h of sepsis onset. Results We included 53 patients. Thirty-four (64%) patients received thiamine. Five patients (15%) received their first thiamine dose in the emergency department. The median time to thiamine administration was 9 (quartiles: 4, 18) hours. The first thiamine dose was most often given parenterally (68%) and for 100 mg (88%). In those receiving thiamine, 15/34 (44%) died, compared to 15/19 (79%) of those not receiving thiamine, p = 0.02. Conclusions A considerable proportion of patients with AUDs admitted for septic shock do not receive thiamine. Thiamine administration in this patient population was associated with decreased mortality.
AB - Purpose Alcohol-use disorders (AUDs) have been associated with increased sepsis-related mortality. As patients with AUDs are often thiamine deficient, we investigated practice patterns relating to thiamine administration in patients with AUDs presenting with septic shock and explored the association between receipt of thiamine and mortality. Materials We performed a retrospective cohort study of patients presenting with septic shock between 2008 and 2014 at a single tertiary care center. We identified patients with an AUD diagnosis, orders for microbial cultures and use of antibiotics, vasopressor dependency, and lactate levels ≥ 4 mmol/L. We excluded those who received thiamine later than 48 h of sepsis onset. Results We included 53 patients. Thirty-four (64%) patients received thiamine. Five patients (15%) received their first thiamine dose in the emergency department. The median time to thiamine administration was 9 (quartiles: 4, 18) hours. The first thiamine dose was most often given parenterally (68%) and for 100 mg (88%). In those receiving thiamine, 15/34 (44%) died, compared to 15/19 (79%) of those not receiving thiamine, p = 0.02. Conclusions A considerable proportion of patients with AUDs admitted for septic shock do not receive thiamine. Thiamine administration in this patient population was associated with decreased mortality.
KW - Alcohol use disorder
KW - EtOH
KW - Sepsis
KW - Septic shock
KW - Thiamine
KW - Vitamin B1
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U2 - 10.1016/j.jcrc.2017.08.022
DO - 10.1016/j.jcrc.2017.08.022
M3 - Article
C2 - 28850930
AN - SCOPUS:85037677328
SN - 0883-9441
VL - 43
SP - 61
EP - 64
JO - Seminars in Anesthesia
JF - Seminars in Anesthesia
ER -
