(1472) Evaluation of Supplemental Thiamine on Lactate Clearance in Adults With Septic Shock in the ICU

Introduction: Critically ill patients with thiamine (vitamin B1) deficiency may have decreased activity of pyruvate dehydrogenase, resulting in increased production of lactic acid. Elevated serum lactate has been found to be correlated with increased mortality. The purpose of this study is to evaluate the effect of supplemental thiamine administration on lactate clearance in adults with septic shock in the ICU.

Methods: This study was a single-center, retrospective chart review of adult septic shock patients admitted to the ICU (cardiac, surgical, or medical) between January 1, 2021 and April 30, 2023. Patients were excluded if they were SARS-CoV-2 positive, received epinephrine, experienced seizures, cardiac arrest, or received thiamine for indications other than lactate clearance. Patients who received thiamine within 72 hours were compared to those who did not receive thiamine. Data collection included baseline serum lactate (mmol/L), repeat serum lactate within 72 hours, lactate clearance, in-hospital mortality, and hospital and ICU length of stay (LOS).

Results: A total of 61 patients were included in this study. Of those included, 38 patients received thiamine while the remaining 23 did not. The mean age of patients included was 69 (±14.4) years, of which 52% were female. There was no difference detected in lactate clearance within 72 hours (-0.097 vs -0.77, p=0.34) or in-hospital mortality (50% vs 44%, p=0.79) between thiamine and control groups, respectively. However, while hospital LOS was lower in the thiamine group (4.3 vs 10.2 days, p< 0.01), ICU LOS was increased (9.9 vs 4.2 days, p< 0.01).

Conclusions: Thiamine supplementation did not result in increased lactate clearance in adults with septic shock admitted to the ICU. There was no difference in the in-hospital mortality between groups. Although hospital LOS was decreased in the thiamine group, ICU LOS was increased. Based on these results, further research is required to determine the role of thiamine supplementation on lactate clearance in adults with septic shock in the ICU.