Vitamin C Apparently Not Useful For Sepsis After All
MARY LOUISE KELLY, HOST:
The nation's attention has understandably been on COVID-19 over this past year. But in that same span of time, nearly as many people in the hospital have died with a different condition - sepsis. Researchers have been searching for better ways to treat this disease, which is sometimes called blood poisoning. A new study throws cold water on one treatment that had drawn a great deal of interest in the past few years. NPR science correspondent Richard Harris reports.
RICHARD HARRIS, BYLINE: Back in 2017, a researcher in Norfolk, Va., announced that he had found a remarkable treatment for sepsis, which is basically the body's overreaction to an infection. He used a combination of intravenous vitamin C, thiamin and a steroid and reported a huge benefit. That caught the attention of doctors and researchers around the world, including Dr. Jon Sevransky (ph) at Emory University.
JONATHAN SEVRANSKY: Sepsis is one of the most common causes that people die in the hospital, and so finding a good treatment for this is extraordinarily important.
HARRIS: Sevransky and colleagues set up a careful study of the treatment involving 43 hospitals. It is one of four major studies completed to date, each measuring somewhat different endpoints, but all trying to assess the value of this inexpensive and readily available treatment.
SEVRANSKY: None of the trials showed a difference in what they considered their primary outcome measure.
HARRIS: Sevransky's study, published today in JAMA, was likewise a bust. Now, his study did end earlier than he had hoped after the foundation funding it decided to bail out. But they still gathered data from about 500 patients in the intensive care unit. That makes it the biggest study to date and big enough to see a dramatic effect, had there been one.
SEVRANSKY: We can say with some confidence that if there were such a large effect, we would have seen that in our patients.
PAUL MARIK: Some people think the matter is dead. We would disagree.
HARRIS: That's Dr. Paul Marik, a critical care specialist at Eastern Virginia Medical School, who published those early dramatic claims. Marik says the treatment must be given sooner than it was in the studies. He now gives the infusions when people first show up in the emergency room and doesn't wait for the hours or sometimes days it takes before someone ends up in the intensive care unit.
MARIK: This should really be an emergency department study, not an ICU study. Once you've waited till they get to the ICU, you've missed the boat.
HARRIS: Conducting research in the emergency department is much harder because it's tricky to explain a study and get permission in the midst of a health crisis. Marik says researchers in Belgium are trying to do that, though, with a treatment he developed. In the meantime, doctors who have been using this treatment face a decision. Should they keep doing it, given all these disappointing results? Dr. Christopher Seymour at the University of Pittsburgh says it's similar to the issue they are confronting as they explore unproven treatments for COVID-19.
CHRISTOPHER SEYMOUR: What if the drug has no demonstrable treatment benefit but doesn't show any harm? Should we just give it with the hope that if the, quote, "kitchen sink" is thrown at the patient, there will be a benefit? I don't think so, in part because that distracts us from the science and the clinical care that actually might be making a difference.
HARRIS: At Emory, Dr. Sevransky confronts this all the time.
SEVRANSKY: I can't tell you how many discussions I've had with patients over the past year and their families over how to decide whether or not to give something that has been touted or in the news.
HARRIS: It can be a huge drain on time and resources. And it could also backfire, he says.
SEYMOUR: If you focus on something that might work, sometimes you take your eye off the ball and don't focus on something that you know works.
HARRIS: That's true in a pandemic and true for the deadly disease of sepsis as well.
Richard Harris, NPR News.
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