الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Vitamin C has been known for over 20 years that in acutely-ill patients, and in the experimental models of sepsis in which an acute deficiency of vitamin C develops, there is low serum and intracellular levels of the vitamin. Critically ill septic patients typically have very low or undetectable serum levels of vitamin C, resulting in an acute scorbutic condition. Thiamine is the precursor of TPP, which is an essential coenzyme of several decarboxylases required for glucose metabolism, the Krebs cycle and the generation of ATP. Thiamine plays an important role in many enzymatic processes involved in brain function maintenance and inter neuronal communication. Thiamine has anti-inflammatory effects, suppressing the oxidative stress-induced activation of NF-κB. Glucocorticoids have diverse anti-inflammatory properties. Glucocorticoids affect nearly every cell of the immune system. Glucocorticoids suppress inflammation by multiple mechanisms that impact both the innate and adaptive immune responses. The primary antiinflammatory action of glucocorticoids is to repress a large number of proinflammatory genes, which encode cytokines, chemokines, inflammatory enzymes. In addition to attenuating the pro-inflammatory response, low-dose glucocorticoids have immune-stimulating effects, which may limit the antiinflammatory immunosuppressive state. This study was conducted to evaluate the effect of hydrocortisone, Ascorbic acid and thiamin therapy on the 28th day mortality rate and the outcome in patient with sepsis. ➢ Primary outcome ▪ 28th day mortality rate. ➢ Secondary outcome: ▪ Changes in SOFA score and incidence of organ dysfunction. ▪ Changes in serum pocalcitonin level. ▪ Changes in serum lactate level. ▪ Total dose of vasopressor therapy This prospective randomized controlled double-blinded study was carried out at Surgical Intensive Care Units (SICU) in Tanta University Hospitals for a period of 24 months from November 2019 to October 2021 after approval from institutional ethical committee Patients who met the previous criteria were enrolled in the study. The patients were randomily allocated into two groups by the aid of computer generated software of randomization introduced into sealed closed envelops.. group I- (placebo) The patients in this group was managed only according to the SSC 2016 and the SSC bundle 2018 update. The patients received 50 ml normal saline I.V within 30 mins / 6 h, 5 ml normal saline I.V / 6 h, 10 ml normal saline I.V / 12 h. group II The patients received the conventional therapy of sepsis and combined therapy of hydrocortisone (Solucortif® 100 mg , vial, dried powder Pfizer, Egypt) 50 mg diluted in 5 ml normal saline IV / 6 h, ascorbic acid (VITAMIN C-®, Amp, ROTEXMEDICA, Germany, 500mg/5ml) 1.5 gm diluted in 50 ml normal saline IV within 30 min /6 h , and thiamine (Vitamin B1-injektopas®, Ampoule, Germany, 100 mg / 2 ml) 200 mg diluted in 10 ml normal saline IV /12 h This combined therapy was given for 4 days or to the time of discharge if the admission period was less than 4 days. Measurements All data were collected by intensivists who were blinded about the study groups and not participating in the study. All the patients were subjected to the following: 10. Demographic data (age, gender, weight, cause of sepsis). 11. 28th day mortality (If the patient was discharged, data were collected by phone calls) 12. SOFA score was recorded daily and compared during the period of the studied drugs administration. 13. Incidence of organ dysfunction during the period of ICU stay was recorded. 14. Mean arterial blood pressure were recorded every 8 hrs and compared for four days. 15. Cardiac index was measured every 8 hrs using Electrical Cardiometry monitor, (ICON Cardiotronics, Inc., La Jolla, CA 92307; Osypka Medical GmbH, Berlin, Germany) and was compared between both groups for four days. 16. Total dose of vasopressor therapy was calculated. 17. Serum lactate level was measured daily for four days. Serum procalcitonin level was measured at time of starting the studied drugs administration and at the end of it Results of our study revealed that • The Incidence of 28th day Mortality in both groups was comparable • from day one up to day four, the follow up of SOFA scores were insignificantly different between both groups. • The incidence of organ dysfunction was comparable in both groups. • At day 2,3 and 4, the mean values of MAP were higher in group II as compared to group I • At day 2,3 and 4, the mean values of cardiac index were higher in group I as compared to group II • The total dose of vasopressor therapy was significantly lower in group II • At day 2,3,4 the mean values of serum lactate were higher in group I in comparison to group II • At the 4th day, the serum procalcitonin level was significantly lower in group II.