US doctor finds potentially effective treatment for fatal sepsis

March 24, 2017

An intravenous vitamin and steroid infusion has demonstrated remarkable success in treating patients who at high risk of sudden death due to sepsis, a condition that leads to multiple organ failure and kills more people in the hospital than any other disease, according to a study at the Eastern Virginia Medical School in the US.

Dr. Paul Marik was running the intensive care unit (ICU) at Sentara Norfolk General Hospital in January 2015 when a 48-year-old woman came in with a severe case of sepsis — inflammation frequently triggered by an overwhelming infection. The patient’s kidneys and lungs weren’t working.

“In a situation like this, you start thinking out of the box,”Marik said. Marik had recently read a study by researchers at Virginia Commonwealth University in Richmond. Dr. Berry Fowler and his colleagues had shown some moderate success in treating people who had sepsis with intravenous vitamin C.

Marik decided to give it a try and even added in a low dose of corticosteroids, which are sometimes used to treat sepsis, along with a bit of another vitamin, thiamine. His desperately ill patient got an infusion of this mixture.

Marik was expecting the patient to be dead the next morning. However, he found the patient well on her way to recovery instead.

Marik tried this treatment with the next two sepsis patients he encountered, and was similarly surprised. So he started treating his sepsis patients regularly with the vitamin and steroid infusion.

After he’d treated 50 patients, he decided to write up his results. As he described it in Chest, only four of those 47 patients died in the hospital — and all the deaths were from their underlying diseases, not from sepsis. For comparison, he looked back at 47 patients the hospital had treated before he tried the vitamin C infusion and found that 19 had died in the hospital.

This is not the standard way to evaluate a potential new treatment. Ordinarily, the potential treatment would be tested head to head with a placebo or standard treatment, and neither the doctors nor the patients would know who in the study was getting the new therapy.

But the results were so stunning, Marik decided that from that point on he would treat all his sepsis patients with the vitamin C infusion. So far, he’s treated about 150 patients, and only one has died of sepsis, he said.

That’s a phenomenal claim, considering that of the million Americans a year who get sepsis, about 300,000 die.”So that’s the equivalent of three jumbo jets crashing every single day,” Marik said.

“If it turns out in further studies that this is true, and we can validate it, then this will be an unbelievably huge deal,” said Dr. Craig Coopersmith, a surgery professor at Emory University School of Medicine. “But right now we should treat it as a preliminary deal that needs to be validated.”

Coopersmith, a top sepsis researcher, is still cautious as there have been hundreds of exciting results from sepsis studies that failed in follow-up research.A result “can look really exciting when you do it on a group in one hospital with one set of clinicians, and then when you try to validate with a larger group in multiple centers — thus far we’ve been unsuccessful with anything,” Coopersmith said.

Marik may face extra skepticism because the main ingredient is vitamin C, which has attracted a great deal of skepticism over the years. Fowler at VCU was concerned about that when he wanted to launch a study about the role of vitamin C in sepsis.

“Honestly, when we submitted the grant to the NIH, I was fully expecting them to say ‘vitamin C? Really?'” Fowler tells Shots.But he’d made the case that vitamin C wasn’t simply a once-trendy antioxidant. When the vitamin is injected, as opposed to taken orally, it can influence the immune system’s response to inflammation, he told Shots.

The NIH gave him a US$3.2 million grant to run a carefully controlled study of vitamin C to treat sepsis, with all the usual conditions: It includes placebos; the scientists don’t know who’s getting the active drug; and it’s being conducted at several universities.

That study could wrap up later this year. Fowler says some patients in the trial will probably have been given corticosteroids, as Marik’s patients were, but that’s not a formal part of the study.

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