A simple vitamin cocktail to treat sepsis has shaken up the medical world, raising hopes of a more effective treatment for one of history's great killers, suggests the study
Researchers at several hospitals around the world are trying to reproduce the success reported by a critical-care doctor in Virginia in beating back sepsis, one of the leading causes of hospital deaths.
Paul Marik, MD, chief of pulmonary and critical care medicine at Eastern Virginia Medical School, reported in 2017 that he gave a mix of vitamin C, vitamin B1, and a steroid to nearly four dozen patients who had sepsis in his Norfolk intensive care unit. In the 7 months before he started using the treatment, 19 of 47 sepsis patients died. Of the 47 who got the treatment, all but four survived.
The results got a lot of attention. But it was a small study, comparing before-and-after patient outcomes. Now, researchers are gearing up to test the therapy with large-scale trials using patients selected at random, with some given the cocktail and others were given a placebo.
"Dr. Marik feels very strongly that it's worked in his patients, and he's changed his practice because of his own experience," says Jonathan Sevransky, MD, a critical care doctor at Emory University in Atlanta who is leading one of the studies.
"If you think something works, it makes sense for a doctor to try something and to change their own practice. But if you want to change other people's practices, the way to do that is do a randomized, controlled trial — and ideally, you'd have more than one randomized, controlled trial."
An Ancient Danger
Sepsis has been in the medical books since the time of Hippocrates. It happens when the body's immune system responds to an infection with overwhelming force, triggering complications that can cause blood clots, inflammation, and other problems, leading to organ failure and death.
In the days before sterile instruments and antibiotics, sepsis was a frequent and deadly complication of wounds. It still hits than 1 million people in the United States every year, and between a quarter and half of them die.
Survival often depends on an immediate dose of antibiotics and intravenous fluids, along with tests to look for signs of an infection or organ failure. Estimates of how much it costs to treat sepsis approach $24 billion a year.
Jarone Lee, MD, medical director of the intensive care unit at Massachusetts General Hospital, says finding a good treatment for sepsis would solve a lot of healthcare problems. But it's too early to declare victory without better data, says Lee, who is not involved in the ongoing trials.
"What I think we're looking for is essentially a hard science and great science about how this will work," he says. "It doesn't even have to show the amazing results like Paul did, just that we're moving the needle forward and decreasing mortality or some other process measure that improves outcomes," said Jarone Lee.