Skip to content
2000
Volume 32, Issue 16
  • ISSN: 0929-8673
  • E-ISSN: 1875-533X

Abstract

Background

This systematic review and meta-analysis aimed to determine whether the combination of hydrocortisone, vitamin C (ascorbic acid), and thiamine (HAT therapy) diminishes the mortality and is effective in expediting the resolution of sepsis and septic shock or not.

Methods

The following databases of PubMed, Scopus, ISI Web of Science, and Google Scholar were explored until March 2021 for all existing literature related to this field. An automatic alert for all databases was also activated to update our search. Meta-analysis was performed on clinical trials and cohorts separately as well as on all the pooled populations.

Results

This study evaluated nine clinical trials (1358 participants) and nine cohorts (339,437 participants) and is the most comprehensive systematic review in this field. The results of our meta-analysis demonstrated a significant difference in the reduction of Sepsis-Related Organ Failure Assessment (SOFA) score changes (Δ-SOFA) over 72 h (Standard Mean Difference (SMD) = −0.429; 95% CI: −0.737, 0.120; = 0.006), duration of vasopressor (VP) (SMD = −0.373; 95% CI: −0.619, −0.128; = 0.003), and procalcitonin (PCT) clearance (SMD = 0.496; 95% CI: 0.061, 0.931%; = 0.026). Considering the results of cohorts, HAT therapy was effective in the survival of intensive care units (ICUs) patients (OR = 0.641; 95% CI: 0.423-0.970, = 0.035). However, no significant difference was observed between the intervention and control groups in hospital mortality (Odds Ratio (OR) = 0.811, 95% CI: 0.544-1.209, = 0.304), 28- to 30-day mortality (OR = 1.000; 95% CI: 0.782-1.279, = 0.998), new onset acute kidney injury requiring renal replacement therapy ((OR = 0.856, 95% CI: 0.526, 1.391; = 0.529), in-hospital length of stay (LOS) (SMD = 0.090; 95% CI: −0.036, 0.216 days; = 0.162), LOS in ICU (SMD = 0.016, 95% CI: −0.138, 0.170 days; = 0.838), and mechanical ventilation-free days (SMD = 0.004; 95% CI: −0.154, 0.163 days; = 0.956).

Conclusion

Supplementation of septic and septic shock patients with HAT therapy has significant beneficial effects on SOFA score over 72 hours, duration of exogenous vasopressor infusion and procalcitonin clearance. Considering the results of cohort studies, supplementation with HAT is efficacious in reducing ICU mortality.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/cmc/10.2174/0109298673245464231121094448
2024-01-22
2026-02-20

  • From This Site

    /content/journals/cmc/10.2174/0109298673245464231121094448
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. HagerD.N. HooperM.H. BernardG.R. BusseL.W. ElyE.W. FowlerA.A. GaieskiD.F. HallA. HinsonJ.S. JacksonJ.C. KelenG.D. LevineM. LindsellC.J. MaloneR.E. McGlothlinA. RothmanR.E. VieleK. WrightD.W. SevranskyJ.E. MartinG.S. The Vitamin C, thiamine and steroids in sepsis (VICTAS) protocol: A prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial.Trials201920119710.1186/s13063‑019‑3254‑230953543
     [Google Scholar]
  2. SadakaF. GradyJ. OrgantiN. DonepudiB. KorobeyM. TannehillD. O’BrienJ. Ascorbic acid, thiamine, and steroids in septic shock: Propensity matched analysis.J. Intensive Care Med.202035111302130610.1177/088506661986454131315499
     [Google Scholar]
  3. GandhiH. BalakrishnanM. ShahK. PandyaH. PatelR. KeshwaniS. YadavN. Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery.Indian J. Anaesth.2018621293493910.4103/ija.IJA_361_1830636793
     [Google Scholar]
  4. MarikP.E. KhangooraV. RiveraR. HooperM.H. CatravasJ. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock.Chest201715161229123810.1016/j.chest.2016.11.03627940189
     [Google Scholar]
  5. KaukonenK.M. BaileyM. SuzukiS. PilcherD. BellomoR. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.JAMA2014311131308131610.1001/jama.2014.263724638143
     [Google Scholar]
  6. MasoodH. BurkiA.M. SultanA. SharifH. GhauriA. KhanS. QureshiM.S.S. QadeerA. RasheedG. Effect of intravenous vitamin C, thiamine, and hydrocortisone (the metabolic resuscitation protocol) on early weaning from vasopressors in patients with septic shock. A descriptive case series study.Cureus2019116e501610.7759/cureus.501631497446
     [Google Scholar]
  7. LitwakJ. ChoN. NguyenH. MoussaviK. BushellT. VitaminC. Vitamin C, hydrocortisone, and thiamine for the treatment of severe sepsis and septic shock: A retrospective analysis of real-world application.J. Clin. Med.20198447810.3390/jcm804047830970560
     [Google Scholar]
  8. FujiiT. LuethiN. YoungP.J. FreiD.R. EastwoodG.M. FrenchC.J. DeaneA.M. ShehabiY. HajjarL.A. OliveiraG. UdyA.A. OrfordN. EdneyS.J. HuntA.L. JuddH.L. BitkerL. CioccariL. NaorungrojT. YanaseF. BatesS. McGainF. HudsonE.P. Al-BassamW. DwivediD.B. PeppinC. McCrackenP. OroszJ. BaileyM. BellomoR. Effect of vitamin C, hydrocortisone, and thiamine vs. hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock.JAMA2020323542343110.1001/jama.2019.2217631950979
     [Google Scholar]
  9. MitchellA.B. RyanT.E. GillionA.R. WellsL.D. MuthiahM.P. Vitamin C and thiamine for sepsis and septic shock.Am. J. Med.2020133563563810.1016/j.amjmed.2019.07.05431469984
     [Google Scholar]
  10. BatzofinB.M. SprungC.L. WeissY.G. The use of steroids in the treatment of severe sepsis and septic shock.Best Pract. Res. Clin. Endocrinol. Metab.201125573574310.1016/j.beem.2011.05.00621925074
     [Google Scholar]
  11. VenkateshB. FinferS. CohenJ. RajbhandariD. ArabiY. BellomoR. BillotL. CorreaM. GlassP. HarwardM. JoyceC. LiQ. McArthurC. PernerA. RhodesA. ThompsonK. WebbS. MyburghJ. Adjunctive glucocorticoid therapy in patients with septic shock.N. Engl. J. Med.2018378979780810.1056/NEJMoa170583529347874
     [Google Scholar]
  12. AnnaneD. RenaultA. Brun-BuissonC. MegarbaneB. QuenotJ.P. SiamiS. CariouA. ForcevilleX. SchwebelC. MartinC. TimsitJ.F. MissetB. Ali BenaliM. ColinG. SouweineB. AsehnouneK. MercierE. ChimotL. CharpentierC. FrançoisB. BoulainT. PetitpasF. ConstantinJ.M. DhonneurG. BaudinF. CombesA. BohéJ. LoriferneJ.F. AmathieuR. CookF. SlamaM. LeroyO. CapellierG. DargentA. HissemT. MaximeV. BellissantE. Hydrocortisone plus fludrocortisone for adults with septic shock.N. Engl. J. Med.2018378980981810.1056/NEJMoa170571629490185
     [Google Scholar]
  13. BalkR.A. Steroids for septic shock: Back from the dead? (Pro).Chest20031235490S499S10.1378/chest.123.5_suppl.490S12740234
     [Google Scholar]
  14. HigginsJ.G. Cochrane handbook for systematic reviews of interventions version 5.1.Cochrane Collaboration2011
     [Google Scholar]
  15. SchiavoJ.H. PROSPERO: An international register of systematic review protocols.Med. Ref. Serv. Q.201938217118010.1080/02763869.2019.158807231173570
     [Google Scholar]
  16. YunusI. FasihA. WangY. The use of procalcitonin in the determination of severity of sepsis, patient outcomes and infection characteristics.PLoS One20181311e020652710.1371/journal.pone.020652730427887
     [Google Scholar]
  17. Armijo-OlivoS. StilesC.R. HagenN.A. BiondoP.D. CummingsG.G. Assessment of study quality for systematic reviews: A comparison of the cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool: methodological research.J. Eval. Clin. Pract.2012181121810.1111/j.1365‑2753.2010.01516.x20698919
     [Google Scholar]
  18. PetersonJ. WelchV. LososM. TugwellP. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.OttawaOttawa Hospital Research Institute2011
     [Google Scholar]
  19. EggerM. Davey-SmithG. AltmanD. Systematic reviews in health care: Meta-analysis in context.John Wiley & Sons2008
     [Google Scholar]
  20. DuvalS. TweedieR. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics200056245546310.1111/j.0006‑341X.2000.00455.x10877304
     [Google Scholar]
  21. LyuQ.Q. ZhengR.Q. ChenQ.H. YuJ.Q. ShaoJ. GuX.H. Early administration of hydrocortisone, vitamin C, and thiamine in adult patients with septic shock: A randomized controlled clinical trial.Crit. Care202226129510.1186/s13054‑022‑04175‑x36171582
     [Google Scholar]
  22. JamshidiMR ZeraatiMR ForouzanfarB TahrekhaniM MotamedN Effects of triple combination of hydrocortisone, thiamine, and Vitamin C on clinical outcome in patients with septic shock: A single-center randomized controlled trial.J. Res. Med. Sci.202126
     [Google Scholar]
  23. MenonV. MohamedZ.U. PrasannanP. MoniM. EdathadathilF. PrasannaP. MenonA. NairS. GreeshmaC.R. SathyapalanD.T. MenonV. Vitamin C therapy for routine care in septic shock (ViCTOR) trial: Effect of intravenous vitamin C, thiamine, and hydrocortisone administration on inpatient mortality among patients with septic shock.Indian J. Crit. Care Med.202024865366110.5005/jp‑journals‑10071‑2351733024370
     [Google Scholar]
  24. MoskowitzA. HuangD.T. HouP.C. GongJ. DoshiP.B. GrossestreuerA.V. AndersenL.W. NgoL. SherwinR.L. BergK.M. ChaseM. CocchiM.N. McCannonJ.B. HersheyM. HilewitzA. KorotunM. BeckersL.B. OteroR.M. UdumanJ. SenA. DonninoM.W. Effect of ascorbic acid, corticosteroids, and thiamine on organ injury in septic shock.JAMA2020324764265010.1001/jama.2020.1194632809003
     [Google Scholar]
  25. ChangP. LiaoY. GuanJ. GuoY. ZhaoM. HuJ. ZhouJ. WangH. CenZ. TangY. LiuZ. Combined treatment with hydrocortisone, vitamin C, and thiamine for sepsis and septic shock.Chest2020158117418210.1016/j.chest.2020.02.06532243943
     [Google Scholar]
  26. WaniS.J. MuftiS.A. JanR.A. ShahS.U. QadriS.M. KhanU.H. BagdadiF. MehfoozN. KoulP.A. Combination of vitamin C, thiamine and hydrocortisone added to standard treatment in the management of sepsis: Results from an open label randomised controlled clinical trial and a review of the literature.Infect. Dis.202052427127810.1080/23744235.2020.171820031990246
     [Google Scholar]
  27. SevranskyJ.E. RothmanR.E. HagerD.N. BernardG.R. BrownS.M. BuchmanT.G. BusseL.W. CoopersmithC.M. DeWildeC. ElyE.W. EyzaguirreL.M. FowlerA.A. GaieskiD.F. GongM.N. HallA. HinsonJ.S. HooperM.H. KelenG.D. KhanA. LevineM.A. LewisR.J. LindsellC.J. MarlinJ.S. McGlothlinA. MooreB.L. NugentK.L. NwosuS. PolitoC.C. RiceT.W. RickettsE.P. RudolphC.C. SanfilippoF. VieleK. MartinG.S. WrightD.W. NugentK.L. SpainhourC. PolitoC.C. MooreB.L. NegrinL. KhanA. KeaB. KrolO. HaqE. PinkertV. NguyenK. BrownS.M. BledsoeJ. PeltanI. ApplegateD. ArmbrusterB. MontgomeryQ. BrownK. DawA. GongM.N. AboodiM. ChenJ.T. HopeA. GummadiS. LopezB. HinsonJ.S. HagerD.N. RickettsE.P. ClementsC.M. GajicO. KashyapR. VanmeterD. BusseL.W. McBrideM. GindeA. MossM. FinckL. HowellM. McKeehanJ. HigginsC. ClareJ. McBrydeB. BarksdaleA. KalinD. KruseD. HilzK. QadirN. ChangS.Y. BeutlerR. TamA. HarrisE.S. YoungquistS.T. MiddletonE.A. DavidovE. PlanteA. BelskyJ. SinerJ. WiraC. BrokowskiC. SteingrubJ. SmithlineH. Thornton-ThompsonS. FowlerA.A. MillerS. NarronK. PuskarichM.A. PrekkerM.E. HendricksonA. QuinnJ. WilsonJ. LevittJ. MannR. VisweswaranA. GentileN. MarchettiN. ReimerH. GuirgisF. JonesL. BlackL. HensonM. MeyerN.J. GreenwoodJ.C. IttnerC. RiversE. JayaprakashN. Gardner-GrayJ. HurstG. PflaumJ. JaehneA.K. GillJ. CookA. JanzD.R. VonderhaarD. RomaineC. WilkersonR.G. McCurdyM.T. BeachD. LaskoK. GillR. PriceK. DicksonL. DuggalA. MaceS.E. HiteR.D. HastingsA. HaukoosJ. DouglasI. TrentS. LyleC. CupeloA. GravitzS. HillerT. OakesJ. LoVecchioF. QuirogaP. DanleyS. MulrowM. EncinasA. GoodwinA. HallG. GradyA. ExlineM. TerndrupT. PannuS. RobartE. KarowS. FilesD.C. SmithL. GibbsK. FloresL. PastoresS.M. ShazD.J. KosteleckyN. CaseC. WilkinsE. GaieskiD.F. BaramM. SchweglerD. RenziN. MosierJ.M. HypesC. CampbellE.S. HooperM.H. SillJ. MitchellK. HudockK. LyonsM. GorderK. AhmadY. StuderA. DavisJ. BarrettM. NomuraJ. KnoxJ. ParkP. CoI. McSparronJ. HyzyR. McDonoughK. HannaS. SelfW.H. SemlerM.W. HaysM. BartzR. LimkakengA. SweeneyK. WoodburnR. GoyalM. ZaaqoqA. MoriartyT. OropelloJ. ZhangZ. Effect of Vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis.JAMA2021325874275010.1001/jama.2020.2450533620405
     [Google Scholar]
  28. YelleS. RajyalakshmiB. AluruN. YelleS. RajyalakshmiB. Metabolic resuscitation using hydrocortisone, ascorbic acid, and thiamine: do individual components influence reversal of shock independently?Indian J. Crit. Care Med.202024864965210.5005/jp‑journals‑10071‑2351533024369
     [Google Scholar]
  29. IglesiasJ. VassalloA.V. PatelV.V. SullivanJ.B. CavanaughJ. ElbagaY. Outcomes of metabolic resuscitation using ascorbic acid, thiamine, and glucocorticoids in the early treatment of sepsis.Chest2020158116417310.1016/j.chest.2020.02.04932194058
     [Google Scholar]
  30. ColorettiI. BiagioniE. VenturelliS. MunariE. TosiM. RoatE. BrugioniL. GelminiR. VenturelliC. GirardisM. Adjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study.J. Crit. Care202059374110.1016/j.jcrc.2020.04.01432512351
     [Google Scholar]
  31. TeacheyA. KeithP. TatumE. WatkinsJ. HodgesJ. 1502: Comparison of vitamin C, thiamine, and corticosteroids in patients with sepsis and septic shock.Crit. Care Med.201846173510.1097/01.ccm.0000529504.58537.83
     [Google Scholar]
  32. GreenleyR. FryckbergA. KirkhamJ. WillsieP. WileyJ. SchiersK. Ascorbic acid, thiamine, and hydrocortisone for improving icu mortality outcomes in septic shock.Crit. Care Med.201947
     [Google Scholar]
  33. LongM.T. KoryP. MarikP. VitaminC. Vitamin C, hydrocortisone, and thiamine for septic shock.JAMA2020323212203220410.1001/jama.2020.584432484528
     [Google Scholar]
  34. VailE.A. WunschH. PintoR. BoschN.A. WalkeyA.J. LindenauerP.K. GershengornH.B. Use of hydrocortisone, ascorbic acid, and thiamine in adults with septic shock.Am. J. Respir. Crit. Care Med.2020202111531153910.1164/rccm.202005‑1829OC32706593
     [Google Scholar]
  35. SahebnasaghA. Boostani MoghadamZ. Salehi-AbargoueiA. SaghafiF. Effect of ascorbic acid, corticosteroids, and thiamine (hat therapy) for the treatment of sepsis or septic shock: A systematic review and meta-analysis.Chest20221616A21310.1016/j.chest.2021.12.244
     [Google Scholar]
  36. LevyM.M. EvansL.E. RhodesA. The surviving sepsis campaign bundle: 2018 update.Intensive Care Med.201844692592810.1007/s00134‑018‑5085‑029675566
     [Google Scholar]
  37. TriposkiadisF. KarayannisG. GiamouzisG. SkoularigisJ. LouridasG. ButlerJ. The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications.J. Am. Coll. Cardiol.200954191747176210.1016/j.jacc.2009.05.01519874988
     [Google Scholar]
  38. SchmittingerC.A. DünserM.W. TorgersenC. LucknerG. LorenzI. SchmidS. JoannidisM. MoserP. HasibederW.R. HalabiM. StegerC.M. Histologic pathologies of the myocardium in septic shock: A prospective observational study.Shock201339432933510.1097/SHK.0b013e318289376b23376953
     [Google Scholar]
  39. SchmittingerC.A. TorgersenC. LucknerG. SchröderD.C.H. LorenzI. DünserM.W. Adverse cardiac events during catecholamine vasopressor therapy: A prospective observational study.Intensive Care Med.201238695095810.1007/s00134‑012‑2531‑222527060
     [Google Scholar]
  40. UchimidoR. SchmidtE.P. ShapiroN.I. The glycocalyx: A novel diagnostic and therapeutic target in sepsis.Crit. Care20192311610.1186/s13054‑018‑2292‑630654825
     [Google Scholar]
  41. ChappellD. JacobM. Hofmann-KieferK. BrueggerD. RehmM. ConzenP. WelschU. BeckerB.F. Hydrocortisone preserves the vascular barrier by protecting the endothelial glycocalyx.Anesthesiology2007107577678410.1097/01.anes.0000286984.39328.9618073553
     [Google Scholar]
  42. KehD. BoehnkeT. Weber-CartensS. SchulzC. AhlersO. BerckerS. VolkH.D. DoeckeW.D. FalkeK.J. GerlachH. Immunologic and hemodynamic effects of “low-dose” hydrocortisone in septic shock: A double-blind, randomized, placebo-controlled, crossover study.Am. J. Respir. Crit. Care Med.2003167451252010.1164/rccm.200205‑446OC12426230
     [Google Scholar]
  43. AguilarD. StromJ. ChenQ.M. Glucocorticoid Induced Leucine Zipper inhibits apoptosis of cardiomyocytes by doxorubicin.Toxicol. Appl. Pharmacol.20142761556210.1016/j.taap.2014.01.01324480152
     [Google Scholar]
  44. OhH-Y. NamkoongS. LeeS-J. PorE. KimC-K. BilliarT.R. HanJ-A. HaK-S. ChungH-T. KwonY-G. LeeH. KimY-M. Dexamethasone protects primary cultured hepatocytes from death receptor-mediated apoptosis by upregulation of cFLIP.Cell Death Differ.200613351252310.1038/sj.cdd.440177116167066
     [Google Scholar]
  45. van der PollT. LowryS.F. Lipopolysaccharide-induced interleukin 8 production by human whole blood is enhanced by epinephrine and inhibited by hydrocortisone.Infect. Immun.19976562378238110.1128/iai.65.6.2378‑2381.19979169777
     [Google Scholar]
  46. KatzL. VaagenesP. SafaP. DivenW. Brain enzyme changes as markers of brain damage in rat cardiac arrest model. Effects of corticosteroid therapy.Resuscitation1989171395310.1016/0300‑9572(89)90078‑62538900
     [Google Scholar]
  47. FerreiraF.L. BotaD.P. BrossA. MélotC. VincentJ-L. Serial evaluation of the SOFA score to predict outcome in critically ill patients.JAMA2001286141754175810.1001/jama.286.14.175411594901
     [Google Scholar]
  48. MorenoR. VincentJ.L. MatosR. MendonçaA. CantraineF. ThijsL. TakalaJ. SprungC. AntonelliM. BruiningH. WillattsS. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study.Intensive Care Med.199925768669610.1007/s00134005093110470572
     [Google Scholar]
  49. Mat NorMB Md RalibA Procalcitonin clearance for early prediction of survival in critically ill patients with severe sepsis.Crit. Care Res. pract.201401481930410.1155/2014/819034
     [Google Scholar]
  50. ZayedY. AlzghoulB.N. BanifadelM. VenigandlaH. HydeR. SutchuS. Vitamin C, thiamine, and hydrocortisone in the treatment of sepsis: A meta-analysis and trial sequential analysis of randomized controlled trials.J. Intensive Care Med.20212021088506662098780933511898
     [Google Scholar]
  51. ShiR. TieH. Benefit of hydrocortisone, thiamine, and vitamin C for patients with sepsis or septic shock? Too early to draw conclusions.Crit. Care202024143110.1186/s13054‑020‑03153‑532665029
     [Google Scholar]
  52. WaldE.L. Sanchez-PintoL.N. SmithC.M. MoranT. BadkeC.M. BarhightM.F. MalakootiM.R. Hydrocortisone–ascorbic acid–thiamine use associated with lower mortality in pediatric septic shock.Am. J. Respir. Crit. Care Med.2020201786386710.1164/rccm.201908‑1543LE31916841
     [Google Scholar]
  53. WaldE. Sanchez-PintoL.N. SmithC. MoranT. BadkeC. BarhightM. MalakootiM. 25: Hydrocortisone/ascorbic acid/thiamine use associated with lower mortality in pediatric septic shock.Crit. Care Med.20204811310.1097/01.ccm.0000618600.13062.e9
     [Google Scholar]
  54. HwangS.Y. RyooS.M. ParkJ.E. JoY.H. JangD.H. SuhG.J. KimT. KimY.J. KimS. ChoH. JoI.J. ChungS.P. ChoiS.H. ShinT.G. KimW.Y. Combination therapy of vitamin C and thiamine for septic shock: A multi-centre, double-blinded randomized, controlled study.Intensive Care Med.202046112015202510.1007/s00134‑020‑06191‑332780166
     [Google Scholar]
  55. WuT. HuC. HuangW. XuQ. HuB. LiJ. Effect of combined hydrocortisone, ascorbic acid and thiamine for patients with sepsis and septic shock: A systematic review and meta-analysis. Shock: Injury, Inflammation, and Sepsis.Shock202156688088910.1097/SHK.000000000000178134529397
     [Google Scholar]
/content/journals/cmc/10.2174/0109298673245464231121094448
Loading
Therapeutic Role of HAT Therapy in Sepsis: A Systematic Review and Meta-Analysis
Curr. Med. Chem. 32, 3258 (2025); https://doi.org/10.2174/0109298673245464231121094448
/content/journals/cmc/10.2174/0109298673245464231121094448
/content/journals/cmc/10.2174/0109298673245464231121094448
Loading

Data & Media loading...

Supplements

PRISMA checklist is available as supplementary material on the publisher’s website along with the published article.

file format download Download

  • Article Type:     Review Article
Keyword(s): ascorbic acid; hat therapy; hydrocortisone; Sepsis; septic; shock; thiamine; vitamin C

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test