Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in Sepsis. (ORANGES)
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|ClinicalTrials.gov Identifier: NCT03422159|
Recruitment Status : Completed
First Posted : February 5, 2018
Results First Posted : September 21, 2021
Last Update Posted : September 21, 2021
This study has been created to compare the addition of intravenous (IV) vitamin C, thiamine, and hydrocortisone to the usual standard of care of sepsis and septic shock. Sepsis is a possibly life-threatening condition in which a patient may have organ dysfunction due to an infection. Septic shock is defined as low blood pressure and organ dysfunction that do not improve after administering IV fluids. Standard of care for sepsis and septic shock include early administration of IV antibiotics, IV fluids, and vasopressors if need be to provide oxygen to vital organs.
A large amount of experimental data has shown that vitamin C and corticosteroids decrease the release of inflammatory substances which may lead to organ failure seen in sepsis. Vitamin C and corticosteroids also improve blood flow to vital organs and increase the body's ability to respond well to vasopressor medications used in septic shock. Low blood levels of both thiamine and vitamin C are common in sepsis. The study will be placebo controlled, meaning one group will receive vitamin C, thiamine, and hydrocortisone, and the other will receive an inactive substance ("placebo"). The goal of the study is to compare the effects of receiving vitamin C, thiamine, and hydrocortisone (along with the standard sepsis care) versus placebo and standard sepsis care.
|Condition or disease||Intervention/treatment||Phase|
|Sepsis, Severe Septic Shock||Drug: Ascorbic Acid Drug: Thiamine Drug: Hydrocortisone Drug: Sodium Chloride 0.9%||Phase 2|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||140 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||This is a double-blind placebo controlled study. Only the dispensing pharmacist will be aware of the treatment allocation. Patients will be randomized to receive either vitamin C/hydrocortisone/thiamine or triple placebo using a random number table provided to the dispensing pharmacists. Each patient will be allocated a unique subject ID which will be linked to the randomization sequence. Only the dispensing pharmacists will have a record of the subject ID and randomization sequence.|
|Masking:||Triple (Participant, Care Provider, Investigator)|
|Masking Description:||Patients will be randomized to receive either vitamin C/hydrocortisone/thiamine or triple placebo using a random number table provided to the dispensing pharmacists. Each patient will be allocated a unique subject ID which will be linked to the randomization sequence. Only the dispensing pharmacists will have a record of the subject ID and randomization sequence.|
|Official Title:||Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.|
|Actual Study Start Date :||February 5, 2018|
|Actual Primary Completion Date :||June 5, 2019|
|Actual Study Completion Date :||August 27, 2019|
Experimental: Treatment Arm
Based on published clinical data, vitamin C pharmacokinetic modeling, the package insert as well as the preliminary study by Marik et al, Vitamin C will be administered as an intravenous dose of 6gm per day divided in 4 equal doses. This dosage is reported to be devoid of any complications or side effects. Hydrocortisone will be dosed according to the consensus guidelines of the American College of Critical Care Medicine. Thiamine will be administered according to current recommendations in a dose of 200mg q 12 hourly. This will be continued for 4 days, or less if discharged from the ICU prior.
Drug: Ascorbic Acid
Ascorbic Acid 1.5g IV piggyback every 6 hours for 4 days (or discharge from ICU if prior to 4 days).
Other Name: Vitamin C
Thiamine 200mg IV piggyback every 12 hours for 4 days (or discharge from ICU if prior to 4 days).
Hydrocortisone 50mg IV push every 6 hours for 4 days (or discharge from ICU if prior to 4 days).
Other Name: Solucortef
Placebo Comparator: Placebo Arm
Vitamin C placebo will consist of an identical bag of 100mL normal saline (but with no vitamin C) and will be labeled "Vitamin C or Placebo". Placebo will be infused over 30 minutes as per the infusion instructions of the active vitamin and protected from light with a brown bag. Hydrocortisone placebo will be provided as an identical 3mL syringe as 1mL of normal saline.The thiamine placebo will be placed in a 50mL bag of Normal Saline labeled "Thiamine 200mg or Placebo" and run over 30 minutes (100mL/hr) Placebo patients will receive a matching 50mL bag of Normal Saline. All of these will be given for up to 4 days, or less if discharged from the ICU prior.
Drug: Sodium Chloride 0.9%
Placebo "Ascorbic Acid" 100mL IV piggyback every 6 hours, Placebo "Thiamine" 50mL IV piggyback every 12 hours, and Placebo "Hydrocortisone" IV push every 6 hours for 4 days (or discharge from ICU if prior to 4 days).
Other Name: Placebo
- Time to Vasopressor Independence (Hours) [ Time Frame: From start of vasopressor medication to final discontinuation of vasopressor medication, up to 7 days. ]Defined as the time from starting the active treatment/placebo to discontinuation of all pressors.
- Change in Sequential Organ Failure Assessment (SOFA) Score [ Time Frame: 4 days post-randomization ]Defined as the day 4 post-randomization SOFA score minus the initial SOFA score. The Sequential Organ Failure Assessment (SOFA) Score is a mortality prediction score that is based on the degree of dysfunction of six organ systems. The score is calculated on admission and every 24 hours until discharge using the worst parameters measured during the prior 24 hours SOFA score ranges from 0 (no organ dysfunction) to 24 (highest possible score / organ dysfunction).
- Procalcitonin (PCT) Clearance [ Time Frame: 4 days post-randomization ]PCT at 96 hours minus initial PCT, divided by the initial PCT multiplied by 100.
- ICU Mortality [ Time Frame: From admission to hospital until final discharge from the ICU, up to 28 days. ]ICU mortality rate
- ICU Length of Stay [ Time Frame: From admission to the ICU until final discharge from the ICU, up to an average of 7 days. ]Time from admitting to ICU to discharge.
- Ventilator Free Days [ Time Frame: 28 Days post-randomization ]Number of days alive and off of the ventilator at day 28.
- Hospital Length of Stay [ Time Frame: From admission to the hospital until final discharge, up to 28 days. ]Time from admitting to discharge of hospital stay.
- Hospital Mortality [ Time Frame: Survival until hospital discharge, up to 28 days. ]In-hospital mortality rate.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03422159
|United States, New Jersey|
|Monmouth Medical Center, Southern Campus|
|Lakewood, New Jersey, United States, 08701|
|Community Medical Center|
|Toms River, New Jersey, United States, 08755|