Critical Care Medicine | 2019
1657: CAT EXPOSURE AN UNUSUAL CAUSE OF SEPTIC SHOCK IN A PATIENT WITH DOWN SYNDROME
Abstract
Learning Objectives: Sepsis and septic shock are medical emergencies leading to nearly a 25% mortality rate. Recently, a study by Marik and colleagues introduced a novel regimen of intravenous vitamin C, thiamine, and hydrocortisone (the vitamin C protocol). This regimen has shown promise as a potentially effective and safe sepsis treatment. Since this publication, the Veterans Affairs Medical Center (VAMC) in Memphis, TN has initiated a vitamin C order set in the medical intensive care unit (MICU). The primary outcome of this study is to evaluate hospital mortality in patients with sepsis or septic shock who received the vitamin C protocol compared to historical controls. Secondary outcomes include ICU, 28-day, and 60-day mortality. Methods: This study is a continuation of a retrospective, observational analysis of patients admitted to the Memphis VAMC MICU diagnosed with sepsis or septic shock. Demographics, comorbidities, primary diagnoses, and outcomes were obtained in patients who received the vitamin C protocol. Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scores were calculated on day of MICU admission. These patients will be propensity matched to historical controls based on factors such as age, sex, vasopressor requirements, and laboratory data. Hospital mortality and secondary outcomes of the treatment and control groups will be analyzed. Results: Preliminary results include 35 patients who received the vitamin C protocol. The mean APACHE II score in this group was 26, corresponding to 55% predicted mortality. Actual hospital mortality of these patients was 45% (n=35). After collecting data for the historical control patients and performing a propensity match, hospital mortality rates will be assessed between the treatment and the control groups. Conclusions: Initial study outcomes indicate an increased mortality rate in this veteran population, compared to patients in the study by Marik and colleagues, in which hospital mortality was 8.5% (n=47). These findings may be explained by the higher acuity of illness at baseline in this patient population, as demonstrated by the mean APACHE II score of 26. By continuing to collect data from historical controls, this study will elucidate the impact of the vitamin C protocol on mortality in this Veteran population.