Association Between IV Thiamine and Mortality in Patients With Septic Shock: A Nationwide Observational Study

Objectives: To examine the effect of thiamine administration on mortality in patients with septic shock requiring norepinephrine. Design: Retrospective observational cohort study from July 2010 to March 2017. Setting: More than 1,000 acute care hospitals covering approximately 90% of all tertiary care emergency hospitals in Japan. Patients: Patients with septic shock requiring norepinephrine within 2 days of admission were retrospectively reviewed. Interventions: Patients who received greater than or equal to 100 mg of thiamine within 2 days of admission were included in the thiamine group and those who did not were included in the control group. Measurements and Main Results: We identified a total of 68,571 eligible patients, including 18,780 and 49,791 patients in the thiamine and control groups, respectively. In the thiamine group, 100 and 200 mg of thiamine per day were administered to 10,143 (54.0%) and 7,679 (40.9%) patients, respectively. The 28-day mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791) in the thiamine and control groups, respectively. After adjusting for confounders by inverse probability of treatment weighting, no significant differences were observed between the two groups (risk difference, 0.2%; 95% CI, -0.5% to 0.9%). There were also no significant differences between the 100-mg thiamine group and the control group (risk difference, 0.6%; 95% CI, -0.3% to 1.4%) or between the 200-mg thiamine group and the control group (risk difference, -0.3%; 95% CI, -1.3% to 0.8%). Conclusions: The findings of this nationwide database-based observational study did not support an association between thiamine administration early after admission and the 28-day mortality in patients with septic shock.