(1045) Comparison of Variable Thiamine Dosing Strategies in Critically Ill Patients With Septic Shock

Introduction: Thiamine has been utilized in conjunction with ascorbic acid and hydrocortisone for metabolic resuscitation in septic shock (SS). A recent study found thiamine 500 mg/day) or low (LD
Methods: This retrospective, cohort study included SS patients on HD or LD thiamine for 72 hours without an alternative indication. The primary endpoint was vasopressor alive-and-free days at 30 days. Secondary endpoints included vasopressor free days at 7 and 30 days, percent change in lactate at 24, 48, and 72 hours, percent change in serum creatinine (SCr) at 72 hours, additional vasopressor(s) after thiamine initiation, hospital and ICU length of stay, and 28-day mortality.

Results: A total of 152 SS patients were analyzed (HD=87; LD=65) who were mostly Caucasian (64%) males (53%) on a median of two vasopressors at the time of thiamine initiation. The mean thiamine dose was 1485.6 mg/day in the HD group and 323.8 mg/day in the LD group. Compared to LD, HD utilized more 30 mL/kg of intravenous fluid resuscitation (89 vs 82%) and hydrocortisone at 300 mg/day (69 vs 58%). A difference of 2.29 vasopressor alive-and-free days at 30 days was found (HD=17.13, LD=14.84, p=0.214). For secondary outcomes comparing HD and LD thiamine, reported results are vasopressor free days at 7 days (3.28 vs 3.18) and 30 days (25.66 vs 25.45), percent decrease in lactate at 24 (11 vs 11%), 48 (28 vs 24%), and 72 hours (34 vs 30%), percent decrease in SCr at 72 hours (8 vs 7%), need for additional vasopressor(s) after thiamine initiation (33 vs 40%), hospital (23.72 vs 23.75) and ICU (13.71 vs 17.26) length of stay, and 28-day mortality (39 vs 52%).

Conclusions: For SS patients that received HD thiamine, patients had more vasopressor alive-and-free days, reduced ICU length of stay, and decreased risk of 28-day mortality, as compared to the LD thiamine group. Prospective, randomized trials are warranted to validate and further investigate HD thiamine in critically ill patients with SS.