We aimed to compare the effects of vitamin C, glucocorticoids, vitamin B1, combinations of these drugs, and placebo or usual care on longer-term mortality in adults with sepsis or septic shock. MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and WHO-ICTRP were searched. The final search was carried out on September 3rd, 2021. Multiple reviewers independently selected randomized controlled trials (RCTs) comparing very-high-dose vitamin C (≥ 12 g/day), high-dose vitamin C (< 12, ≥ 6 g/day), vitamin C (< 6 g/day), glucocorticoid (< 400 mg/day of hydrocortisone), vitamin B1, combinations of these drugs, and placebo/usual care. We performed random-effects network meta-analysis and, where applicable, a random-effects component network meta-analysis. We used the Confidence in Network Meta-Analysis framework to assess the degree of treatment effect certainty. The primary outcome was longer-term mortality (90-days to 1-year). Secondary outcomes were severity of organ dysfunction over 72 h, time to cessation of vasopressor therapy, and length of stay in intensive care unit (ICU). Forty-three RCTs (10,257 patients) were eligible. There were no significant differences in longer-term mortality between treatments and placebo/usual care or between treatments (10 RCTs, 7,096 patients, moderate to very-low-certainty). We did not find any evidence that vitamin C or B1 affect organ dysfunction or ICU length of stay. Adding glucocorticoid to other treatments shortened duration of vasopressor therapy (incremental mean difference, − 29.8 h [95% CI − 44.1 to − 15.5]) and ICU stay (incremental mean difference, − 1.3 days [95% CI − 2.2 to − 0.3]). Metabolic resuscitation with vitamin C, glucocorticoids, vitamin B1, or combinations of these drugs was not significantly associated with a decrease in longer-term mortality.

我们的目的是比较维生素 C、糖皮质激素、维生素 B1、这些药物的组合以及安慰剂或常规护理对脓毒症或感染性休克成人长期死亡率的影响。检索了 MEDLINE、Embase、CENTRAL、ClinicalTrials.gov 和 WHO-ICTRP。最终检索于2021年9月3日进行。多位评审员独立选择比较极高剂量维生素C（≥12克/天）、高剂量维生素C（< 12，≥6）的随机对照试验（RCT）克/天）、维生素 C（< 6 克/天）、糖皮质激素（< 400 毫克/天氢化可的松）、维生素 B1、这些药物的组合以及安慰剂/常规护理。我们进行了随机效应网络荟萃分析，并在适用的情况下进行了随机效应分量网络荟萃分析。我们使用网络荟萃分析框架的置信度来评估治疗效果的确定性程度。主要结局是长期死亡率（90 天至 1 年）。次要结局是 72 小时内器官功能障碍的严重程度、停止升压药治疗的时间以及在重症监护室 (ICU) 的住院时间。 43 项随机对照试验（10,257 名患者）符合资格。治疗与安慰剂/常规护理之间或治疗之间的长期死亡率没有显着差异（10 项随机对照试验，7,096 名患者，中度至极低确定性）。我们没有发现任何证据表明维生素 C 或 B1 会影响器官功能障碍或 ICU 住院时间。在其他治疗中添加糖皮质激素可缩短升压药治疗的持续时间（增量平均差，− 29.8 小时 [95% CI − 44.1 至 − 15.5]）和 ICU 停留时间（增量平均差，− 1.3 天 [95% CI − 2.2 至 − 0.3]） ）。 使用维生素 C、糖皮质激素、维生素 B1 或这些药物的组合进行代谢复苏与长期死亡率的降低没有显着相关性。