Biomarker analysis for combination therapy of vitamin C and thiamine in septic shock: a post-hoc study of the ATESS trial

Introduction We evaluated the effect of administration of vitamin C and thiamine on biomarkers in patients with septic shock. Material & Method This is a post-hoc analysis of the ATESS (the Ascorbic Acid and Thiamine Effect in Septic Shock) trial, a multi-centre, double-blind, randomized, controlled trial. Patients were randomized to the treatment group (intravenous vitamin C and thiamine for 48h) or control group. Serial biomarkers including interleukin (IL), IL-6, IL-10, Angiopoietin-II (AP2) and S100β were assessed at baseline and at 72 h. The primary outcome was the levels of four biomarkers at 72h. Result A total of 97 patients were analysed, of which 45 were assigned to the treatment group and 52 were assigned to the control group. The baseline levels of biomarkers were balanced between the treatment and the control group. The level of all biomarkers at 72h were not significantly different between the two group, but they were significantly higher in the non-survival group compared with the survival group. The four biomarkers at 72 h showed acceptable diagnostic accuracy for predicting 28-day mortality by the area under the receiver operating characteristic (ROC) curve. Conclusion Vitamin C and thiamine administration in the early phase of septic shock did not significantly change the level of biomarkers including IL-6, IL-10, Angiopoietin-II and S100β.