Coctel de Marik o Terapia HAT (Hidrocortisona, Vitamina C y Tiamina) en sepsis. Revisión crítica y controversias actuales a propósito de un caso.
DOI:
https://doi.org/10.30445/rear.v13i4.898Palabras clave:
Sepsis, Shock séptico, Vitamina C, Tiamina, EsteroidesResumen
Marik et al (2017) proponen que la combinación de hidrocortisona, ácido ascórbico y tiamina por vía intravenosa (terapia HAT) es una terapia efectiva para la sepsis. Se basa en un concepto de actuación a través de diversas dianas moleculares que interactúan en múltiples componentes de la respuesta del huésped a agentes infecciosos, regulan la respuesta inmune y evitan la progresión de la sepsis a disfunción multiorgánica y muerte. Paul Marik sugiere que este protocolo es curativo para la sepsis. Esta terapia se aboga por ser una combinación de agentes fácilmente disponibles, seguros y baratos. El protocolo Marik ha sido adoptado por unidades de cuidados críticos de todo el mundo. Un reciente estudio multicéntrico (Vitamins-2020) proporciona evidencias de que esta combinación no es superior al uso aislado de hidrocortisona.
Citas
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- Marik PE. Patterns of Death in Patients with Sepsis and the Use of Hydrocortisone, Ascorbic Acid, and Thiamine to Prevent These Deaths. Surg Infect (Larchmt) 2018; 19(8):812-820.
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- Lin LL, Gu HY, Luo J, Wang L, Zhang C, Niu YM, Zuo HX. Impact and beneficial critical points of clinical outcome in corticosteroid management of adult patients with Sepsis: Meta-Analysis and GRADE Assessment. Front Pharmacol 2019 Sep 24; 10:1101. doi: 10.3389/fphar.2019.01101. eCollection 2019.
- Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, et al. Randomized, double-blind, placebo-controlled trial of thiamine as a metabolic resuscitator in septic shock: a pilot study. Crit Care Med 2016; 44(2):360–367.
- Moskowitz A, Andersen LW, Cocchi MN, Karlsson M, Patel PV, Donnino MW. Thiamine as a renal protective agent in septic shock. a secondary analysis of a randomized, double-blind, placebo-controlled trial. Ann Am Thorac Soc 2017; 14(5):737–741.
- Fowler AA, 3rd, Syed AA, Knowlson S, Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med 2014; 12:32.
- Zabet MH, Mohammadi M, Ramezani M, Khalili H. Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock. J Res Pharm Pract 2016; 5(2):94–100.
- Fowler AA, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA 2019 1; 322(13):1261-1270.
- Mitchell AB, Ryan TE, Gillion AR, Wells LD, Muthiah P. Vitamin C and Thiamine for Sepsis and Septic Shock. Am J Med 2019 Aug 28. pii: S0002-9343(19)30699-0. doi: 10.1016/j.amjmed.2019.07.054.
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- Mühlhöfer A, Mrosek S, Schlegel B, Trommer W, Rozario F, Böhles H, et al. High-dose intravenous vitamin C is not associated with an increase of pro-oxidative biomarkers. Eur J Clin Nutr 2004; 58(8):1151-8.
- Kim WY, Jung JW, Choi JC, Shin JW, Kim JY. Subphenotypes in Patients with Septic Shock Receiving Vitamin C, Hydrocortisone, and Thiamine: A Retrospective Cohort Analysis. Nutrients 2019; 11(12). pii: E2976. doi: 10.3390/nu11122976.
- Moskowitz A, Yankama T, Andersen LW, Huang DT, Donnino MW, Grossestreuer AV; ACTS Clinical Trial Investigators. Ascorbic Acid, Corticosteroids and Thiamine in Sepsis (ACTS) protocol and statistical analysis plan: a prospective, multicentre, double-blind, randomised, placebo-controlled clinical trial. BMJ Open 2019; 17; 9(12):e034406. doi: 10.1136/bmjopen-2019-034406.
- Hager DN, Hooper MH, Bernard GR, Busse LW, Ely EW, Fowler AA, et al. The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) Protocol: a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial. Trials 2019; 5; 20(1):197. doi: 10.1186/s13063-019-3254-2.
- Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, et al; VITAMINS Trial Investigators. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA 2020 Jan 17. doi: 10.1001/jama.2019.22176.
- Carr AC, Rosengrave PC, Bayer S, et al. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Crit Care 2017; 21(1):300. doi: 10.1186/s13054-017-1891-y.
- Marik PE. Patterns of Death in Patients with Sepsis and the Use of Hydrocortisone, Ascorbic Acid, and Thiamine to Prevent These Deaths. Surg Infect (Larchmt) 2018; 19(8):812-820.
- Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, vitamin C and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest 2017; 151(6):1229–1238.
- Marsilio NR, Silva Dd, Bueno D. Drug incompatibilities in the adult intensive care unit of a university hospital. Incompatibilidades medicamentosas em centro de tratamento intensivo adulto de um hospital universitário. Rev Bras Ter Intensiva 2016; 28(2):147–153.
- Keh D, Trips E, Marx G, Wirtz SP, Abduljawwad E, Bercker S et al. Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial. JAMA 2016 Nov 1; 316(17):1775-1785.
- Lin LL, Gu HY, Luo J, Wang L, Zhang C, Niu YM, Zuo HX. Impact and beneficial critical points of clinical outcome in corticosteroid management of adult patients with Sepsis: Meta-Analysis and GRADE Assessment. Front Pharmacol 2019 Sep 24; 10:1101. doi: 10.3389/fphar.2019.01101. eCollection 2019.
- Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, et al. Randomized, double-blind, placebo-controlled trial of thiamine as a metabolic resuscitator in septic shock: a pilot study. Crit Care Med 2016; 44(2):360–367.
- Moskowitz A, Andersen LW, Cocchi MN, Karlsson M, Patel PV, Donnino MW. Thiamine as a renal protective agent in septic shock. a secondary analysis of a randomized, double-blind, placebo-controlled trial. Ann Am Thorac Soc 2017; 14(5):737–741.
- Fowler AA, 3rd, Syed AA, Knowlson S, Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med 2014; 12:32.
- Zabet MH, Mohammadi M, Ramezani M, Khalili H. Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock. J Res Pharm Pract 2016; 5(2):94–100.
- Fowler AA, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA 2019 1; 322(13):1261-1270.
- Mitchell AB, Ryan TE, Gillion AR, Wells LD, Muthiah P. Vitamin C and Thiamine for Sepsis and Septic Shock. Am J Med 2019 Aug 28. pii: S0002-9343(19)30699-0. doi: 10.1016/j.amjmed.2019.07.054.
- Hudson EP, Collie JT, Fujii T, Luethi N, Udy AA, et al. Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock. Crit Care Resusc 2019; 21(4):236-42.
- Mühlhöfer A, Mrosek S, Schlegel B, Trommer W, Rozario F, Böhles H, et al. High-dose intravenous vitamin C is not associated with an increase of pro-oxidative biomarkers. Eur J Clin Nutr 2004; 58(8):1151-8.
- Kim WY, Jung JW, Choi JC, Shin JW, Kim JY. Subphenotypes in Patients with Septic Shock Receiving Vitamin C, Hydrocortisone, and Thiamine: A Retrospective Cohort Analysis. Nutrients 2019; 11(12). pii: E2976. doi: 10.3390/nu11122976.
- Moskowitz A, Yankama T, Andersen LW, Huang DT, Donnino MW, Grossestreuer AV; ACTS Clinical Trial Investigators. Ascorbic Acid, Corticosteroids and Thiamine in Sepsis (ACTS) protocol and statistical analysis plan: a prospective, multicentre, double-blind, randomised, placebo-controlled clinical trial. BMJ Open 2019; 17; 9(12):e034406. doi: 10.1136/bmjopen-2019-034406.
- Hager DN, Hooper MH, Bernard GR, Busse LW, Ely EW, Fowler AA, et al. The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) Protocol: a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial. Trials 2019; 5; 20(1):197. doi: 10.1186/s13063-019-3254-2.
- Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, et al; VITAMINS Trial Investigators. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA 2020 Jan 17. doi: 10.1001/jama.2019.22176.
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2021-05-10
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Sáenz, M. C., González, D. R., Orrego, A. G., & Martín, J. S. (2021). Coctel de Marik o Terapia HAT (Hidrocortisona, Vitamina C y Tiamina) en sepsis. Revisión crítica y controversias actuales a propósito de un caso. Revista Electrónica AnestesiaR, 13(4). https://doi.org/10.30445/rear.v13i4.898
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