Journal of the National Medical Association · 2026
Thiamine and vitamin C supplementation in lactic acidosis: A propensity-matched analysis of clinical outcomes.
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Amir Abdulla, Minhas Manroop, Beyene Elizabeth, Ononenyi Chukwudalu, Deverapalli Mrinalini, Michael Miriam
Аннотация
BACKGROUND: Lactic acidosis is a life-threatening condition associated with high morbidity and mortality. Micronutrient deficiencies, particularly of thiamine and vitamin C, may exacerbate metabolic dysfunction in critically ill patients. While these vitamins are often empirically administered, evidence regarding their clinical impact in lactic acidosis remains limited. We aimed to assess the association between thiamine and vitamin C supplementation and clinical outcomes in hospitalized patients with lactic acidosis.
METHODS: A retrospective analysis was conducted using the TriNetX Global Collaborative Network. Adult patients hospitalized with lactic acidosis were identified based on diagnostic codes and laboratory criteria. Patients were categorized according to receipt of both thiamine and vitamin C during hospitalization versus no supplementation. Propensity score matching (1:1) was performed to balance baseline characteristics, including age, sex, chronic kidney disease, and diabetes mellitus. Outcomes assessed within 30 days included resolution of acidosis, all-cause mortality, preserved ejection fraction, and emergency room utilization. Effect estimates were reported as risk ratios with 95% confidence intervals, and time-to-event analyses were performed using Kaplan-Meier analysis.
RESULTS: After matching, each cohort included 95,358 patients. Resolution of acidosis occurred in 65.2% of supplemented patients versus 57.5% of controls (RR 1.13, 95% CI: 1.13-1.14, p Conclusion: Thiamine and vitamin C supplementation was associated with improved resolution of acidosis and higher EF but unexpectedly correlated with increased mortality and ER visits. These results may reflect confounding by indication, as more severely ill patients likely received supplementation. Randomized controlled trials are warranted to clarify causality and guide clinical practice.
METHODS: A retrospective analysis was conducted using the TriNetX Global Collaborative Network. Adult patients hospitalized with lactic acidosis were identified based on diagnostic codes and laboratory criteria. Patients were categorized according to receipt of both thiamine and vitamin C during hospitalization versus no supplementation. Propensity score matching (1:1) was performed to balance baseline characteristics, including age, sex, chronic kidney disease, and diabetes mellitus. Outcomes assessed within 30 days included resolution of acidosis, all-cause mortality, preserved ejection fraction, and emergency room utilization. Effect estimates were reported as risk ratios with 95% confidence intervals, and time-to-event analyses were performed using Kaplan-Meier analysis.
RESULTS: After matching, each cohort included 95,358 patients. Resolution of acidosis occurred in 65.2% of supplemented patients versus 57.5% of controls (RR 1.13, 95% CI: 1.13-1.14, p Conclusion: Thiamine and vitamin C supplementation was associated with improved resolution of acidosis and higher EF but unexpectedly correlated with increased mortality and ER visits. These results may reflect confounding by indication, as more severely ill patients likely received supplementation. Randomized controlled trials are warranted to clarify causality and guide clinical practice.