Influência da suplementação de tiamina na mortalidade de pacientes com choque séptico
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Data
2022-02-24
Autores
Pereira, Amanda Gomes [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O choque séptico é caracterizado por hipotensão e hipoperfusão tecidual, associadas a aumento do lactato, refratárias à expansão volêmica adequada, sendo necessário o uso de vasopressores para manter a estabilidade hemodinâmica. Por se tratar de condição com elevada mortalidade, terapias coadjuvantes têm sido propostas como forma de melhorar o prognóstico dos pacientes. Nesse sentido, estudos têm explorado o papel da tiamina como ressuscitador metabólico em pacientes com choque séptico. Objetivo: Avaliar a influência da suplementação de tiamina na mortalidade em pacientes com choque séptico. Métodos: Estudo prospectivo, controlado, duplo-cego e randomizado, que incluiu 115 pacientes consecutivos, maiores de 18 anos, com diagnóstico de choque séptico na admissão na Unidade de Terapia Intensiva (UTI). Os pacientes foram alocados em dois grupos: suplementação de tiamina (200 mg de 12 em 12 horas, intravenosa, por 5 dias) e placebo (SF 0,9% em volume, frequência e período iguais a tiamina). Foram coletados dados clínicos, laboratoriais e amostras de sangue antes do início da suplementação e 48 horas após. Resultados: Dos pacientes, 57 pertenceram ao grupo tiamina e 58 ao grupo placebo. A média de idade foi de 63,3 ± 15,7 anos e 55,6% eram do sexo masculino. A mediana dos valores séricos de tiamina antes do tratamento foi de 35,4 ng/mL (24,7 – 51,9), sendo que apenas 8% dos pacientes (n=9) apresentaram deficiência (<16 ng/mL). Após 48 horas, a mediana das concentrações séricas de tiamina foram 51,5 (35,6 – 85,3) ng/mL e 33,7 (21,5 – 52,8) ng/mL (p= 0,003) nos grupos tiamina e placebo, respectivamente. A mediana do tempo de internação na UTI e hospitalar foi de 7 (4 – 16) dias e 16 (9 – 30) dias, respectivamente. A mortalidade em 28 dias foi de 58,2% (n = 67). Não houve diferença estatisticamente significante na mortalidade entre os grupos (Tiamina: 32 [56,1%] vs. Placebo: 35[60,3%]), assim como no tempo de internação na UTI e hospitalar e no tempo livre de ventilação mecânica e de uso de vasopressor. Conclusão: A suplementação de tiamina na dose de 400 mg/dia por 5 dias não apresentou efeito na mortalidade em pacientes com choque séptico.
Introduction: Septic shock is characterized by hypotension and tissue hypoperfusion, associated with increased lactate, refractory to appropriate volume expansion, and requiring the use of vasopressors to maintain hemodynamic stability. Due to its high mortality, supporting therapies have been explored to improve the prognosis of patients. In this sense, studies have explored the role of thiamine as a metabolic resuscitator in patients with septic shock. Aims: To evaluate the influence of thiamine supplementation on mortality in patients with septic shock. Methods: A prospective, controlled, double-blind, randomized study that included 115 consecutive patients, over 18 years old, diagnosed with septic shock on admission to the Intensive Care Unit (ICU). The patients were divided into two groups: thiamine supplementation (200 mg every 12 hours, intravenous, for 5 days) and placebo (saline solution 0.9% in volume, frequency, and period equal to thiamine). Clinical, laboratory data and blood samples were collected before the start of thiamine administration and 48 hours after. Results: 57 patients were in the thiamine group and 58 patients in the placebo group. The mean age was 63.3 ± 15.7 years and 55.6% were male. The median serum thiamine values before treatment were 35.4 ng/mL (24.7 - 51.9) and only 8% of patients (n = 9) having a deficiency (<16 ng/mL). After 48 hours, the median serum thiamine concentrations were 51.5 (35.6 - 85.3) ng/mL and 33.7 (21.5 - 52.8) ng/mL (p = 0.003) in the thiamine and placebo group, respectively. The median ICU and hospital length of stay were 7 (4 - 16) days and 16 (9 - 30) days, respectively. The 28-days mortality was 58.2% (n = 67). There was no statistically significant difference in mortality between the groups (Thiamine: 32 [56.1%] vs. Placebo: 35[60.3%]), as well as the length of ICU and hospital stay, and ventilator and vasopressor-free days. Conclusion: Thiamine administration of 400 mg for 5 days did not affect mortality in patients with septic shock.
Introduction: Septic shock is characterized by hypotension and tissue hypoperfusion, associated with increased lactate, refractory to appropriate volume expansion, and requiring the use of vasopressors to maintain hemodynamic stability. Due to its high mortality, supporting therapies have been explored to improve the prognosis of patients. In this sense, studies have explored the role of thiamine as a metabolic resuscitator in patients with septic shock. Aims: To evaluate the influence of thiamine supplementation on mortality in patients with septic shock. Methods: A prospective, controlled, double-blind, randomized study that included 115 consecutive patients, over 18 years old, diagnosed with septic shock on admission to the Intensive Care Unit (ICU). The patients were divided into two groups: thiamine supplementation (200 mg every 12 hours, intravenous, for 5 days) and placebo (saline solution 0.9% in volume, frequency, and period equal to thiamine). Clinical, laboratory data and blood samples were collected before the start of thiamine administration and 48 hours after. Results: 57 patients were in the thiamine group and 58 patients in the placebo group. The mean age was 63.3 ± 15.7 years and 55.6% were male. The median serum thiamine values before treatment were 35.4 ng/mL (24.7 - 51.9) and only 8% of patients (n = 9) having a deficiency (<16 ng/mL). After 48 hours, the median serum thiamine concentrations were 51.5 (35.6 - 85.3) ng/mL and 33.7 (21.5 - 52.8) ng/mL (p = 0.003) in the thiamine and placebo group, respectively. The median ICU and hospital length of stay were 7 (4 - 16) days and 16 (9 - 30) days, respectively. The 28-days mortality was 58.2% (n = 67). There was no statistically significant difference in mortality between the groups (Thiamine: 32 [56.1%] vs. Placebo: 35[60.3%]), as well as the length of ICU and hospital stay, and ventilator and vasopressor-free days. Conclusion: Thiamine administration of 400 mg for 5 days did not affect mortality in patients with septic shock.
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Palavras-chave
Tiamina, Mortalidade, Choque séptico, Vitamin B1, Mortality