Thiamine in septic shock patients with alcohol use disorders: An observational pilot study

Publikation: Forskning - peer reviewTidsskriftartikel

DOI

  • Mathias Johan Holmberg
  • Ari Moskowitz
    Ari MoskowitzDepartment of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: amoskowi@bidmc.harvard.edu.
  • Parth Vijay Patel
    Parth Vijay PatelCenter for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: pvpatel@bidmc.harvard.edu.
  • Anne Victoria Grossestreuer
    Anne Victoria GrossestreuerCenter for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: agrosses@bidmc.harvard.edu.
  • Amy Uber
    Amy UberCenter for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: auber@bidmc.harvard.edu.
  • Nikola Stankovic
  • Lars Wiuff Andersen
  • Michael William Donnino
    Michael William DonninoCenter for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: mdonnino@bidmc.harvard.edu.

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≥4mmol/L. We excluded those who received thiamine later than 48h 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 100mg (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.

OriginalsprogEngelsk
TidsskriftJournal of critical care
Vol/bind43
Sider (fra-til)61-64
Antal sider4
ISSN0883-9441
DOI
StatusUdgivet - feb. 2018

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