26 March 2017

A Cheap Effective Cure For Sepsis? Probably yes.

Last year a Virginia doctor discovered a new therapy for sepsis that appears to be highly effective in short order with no side effects, despite using only common place inexpensive components in an IV administration. Specifically, it consists of an IV administration of Vitamin C, thiamine (which helps the body absorb vitamin C) and steroids (which work in a manner similar to Vitamin C in some respects).

This remarkable simple treatment appears to be the real deal and could save 30,000+ lives per year in the United States alone. It is already supported by a published academic journal article show extreme levels of effectiveness in a small sample.

If you know someone currently suffering from sepsis who is not receiving this treatment, you should pass this information along immediately.
Sepsis is a condition that leads to multiple organ failure. It is estimated that nearly 8 million people die each year from the disease. 
The breakthrough moment for Dr. Paul Marik, the Chief of Critical Care at EVMS [Eastern Virginia Medical School], came in 2016. Dr. Marik was running the general intensive care unit at Sentara Norfolk General when a 48-year-old woman was admitted with a severe case of sepsis. "Her kidneys had failed, her lungs had failed, I just knew she was going to die," said Dr. Marik. The available treatment options were running out. 
It just so happened that a few weeks earlier, Dr. Marik read about Vitamin C as a possible treatment for sepsis. Septic patients are said to have little or undetectable levels of Vitamin C in their cells. Keeping in mind that Vitamin C and steroids work similarly, Dr. Marik asked his staff to combine the two and inject them into the patient intravenously. 
The results were unexpected. Within hours, the patient was reportedly recovering. Within two days, Dr. Marik gave her an 'ok' to leave the ICU. In the following days, two more patients, who were seemingly destined to die of sepsis, received this treatment. Twice more the patients recovered. 
The treatment became standard for Dr. Marik and his team began. Later, thiamine was added into the mix, as sick patients often are deficient in thiamine (thiamine helps cells absorb vitamin C). 
To validate the findings that many called 'too good to be true', Dr. Marik and his staff teamed up with scientists at Old Dominion University. The results: confirmed, according to Dr. John Catravas, the Interim Executive Director and Sentara Endowed Chair of the Frank Reidy Research Center for Bioelectrics at ODU.

Next step: further research across a much larger patient population.

Dr. Marik says his 'cure' provides no side effects. He hopes other physicians and doctors begin using his method before the results of the trials conclude. "This is an intervention that is readily available, cheap and has the potential to save millions of lives," said Dr. Marik.
The doctor's website related to this treatment is here. The journal article abstract and citation are as follows:
The global burden of sepsis is estimated as 15 to 19 million cases annually with a mortality rate approaching 60% in low income countries. 
In this retrospective before-after clinical study, we compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone and thiamine during a 7-month period (treatment group) compared to a control group treated in our ICU during the preceding 7 months. The primary outcome was hospital survival. A propensity score was generated to adjust the primary outcome. 
There were 47 patients in both treatment and control groups with no significant differences in baseline characteristics between the two groups. The hospital mortality was 8.5% (4 of 47) in the treatment group compared to 40.4% (19 of 47) in the control group (p < 0.001). The propensity adjusted odds of mortality in the patients treated with the vitamin C protocol was 0.13 (95% CI 0.04-0.48, p=002). The SOFA score decreased in all patients in the treatment group with none developing progressive organ failure. Vasopressors were weaned off all patients in the treatment group, a mean of 18.3 ± 9.8 hours after starting treatment with vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4 hours in the control group (p<0.001). 
Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine may prove to be effective in preventing progressive organ dysfunction including acute kidney injury and reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings.

I am taking the unusual step of reprinting the Marik sepsis protocol below the fold because of its potential life saving benefits that should be spread far and wide as quickly as possible.

Why care?

Sepsis is one of the most common causes of death in the developed world associated with an infection. It was the tenth leading cause of death in women and in Africa-Americans the United States in 2014.

Per Wikipedia:
Sepsis is a life-threatening condition that arises when the body's response to infection injures its own tissues and organs. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion. There also may be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection. In the very young, old, and people with a weakened immune system, there may be no symptoms of a specific infection and the body temperature may be low or normal, rather than high. Severe sepsis is sepsis causing poor organ function or insufficient blood flow. Insufficient blood flow may be evident by low blood pressure, high blood lactate, or low urine output. Septic shock is low blood pressure due to sepsis that does not improve after reasonable amounts of intravenous fluids are given. 
Sepsis is caused by an immune response triggered by an infection. Most commonly, the infection is bacterial, but it may also be from fungi, viruses, or parasites. Common locations for the primary infection include lungs, brain, urinary tract, skin, and abdominal organs. Risk factors include young or old age, a weakened immune system from conditions such as cancer or diabetes, major trauma, or burns. . . .  
Sepsis usually is treated with intravenous fluids and antibiotics. Typically, antibiotics are given as soon as possible. Often, ongoing care is performed in an intensive care unit. If fluid replacement is not enough to maintain blood pressure, medications that raise blood pressure may be used. Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively. To guide treatment, a central venous catheter and an arterial catheter may be placed for access to the bloodstream. Other measurements such as cardiac output and superior vena cava oxygen saturation may be used. People with sepsis need preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent such interventions. Some might benefit from tight control of blood sugar levels with insulin.The use of corticosteroids is controversial. . . . 
The risk of death from sepsis is as high as 30%, from severe sepsis as high as 50%, and from septic shock as high as 80%. The number of cases worldwide is unknown as there is little data from the developing world. Estimates suggest sepsis affects millions of people a year. In the developed world approximately 0.2 to 3 people per 1000 are affected by sepsis yearly, resulting in about a million cases per year in the United States. Rates of disease have been increasing. Sepsis is more common among males than females. 
The Marik Sepsis Protocol is as follows:
Vitamin C, Hydrocortisone and Thiamine For the treatment of Severe Sepsis and Septic Shock

Vitamin C, Hydrocortisone and Thiamine dosing protocol 
Vitamin C: 1.5 g IV q 6 hourly for 4 days or until discharge from the ICU. 
Hydrocortisone: 50mg IV push q 6 hourly for 6 days or until discharge from the ICU. Taper is not required. 
Thiamine: 200mg IV q 12 hourly for 4 days or until discharge from the ICU 

Vitamin C: Vitamin C is provided by the manufacturer as a 50 ml vial at a concentration of 500mg/ml. Three (3) ml of vitamin C will be placed in a 100ml bag of either dextrose 5% in water (D5W) or normal saline and infused over 60 minutes. 
Hydrocortisone: Optional dosing strategy: Hydrocortisone 50 mg bolus, followed by a 24-hour continuous infusion of 200 mg for 4 days. 
Thiamine: Intravenous thiamine (200 mg) was placed in a piggyback in 50 ml of either D5W or normal saline and administered as a 15-minute infusion.


Unknown said...

Great to see this and I am wondering, as I have got to it a year late, if you know if the dosage recommended is the one that Dr Marik and colleagues currently use?

andrew said...

My understanding is that it is, although I suspect that research an tinkering is ongoing.

andrew said...

Update: https://pulmccm.org/critical-care-review/vitamin-c-save-lives-sepsis/?fbclid=IwAR3Yf65mnVIQtGIiUs714-20Eq0UMJHcdmc7B9SSr4hkYyblnbPu4-J_d0I

andrew said...

Review article Oct 2018 that also triggers references to related research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206928/

andrew said...

Clinical trials in progress: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3254-2

andrew said...

Discussion of most recent paper in JAMA. https://www.npr.org/sections/health-shots/2019/10/01/766029397/mixed-results-for-a-test-of-vitamin-c-for-sepsis

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