Thiamine Administration May Increase Survival Benefit in Critically Ill Patients with Myocardial Infarction

Overview

Journal Front Nutr

Specialty Nutritional Sciences

Date 2023 Sep 14

PMID 37706212

Authors

Suru Yue

Jia Wang

Yumei Zhao

Enlin Ye

Dongdong Niu

Jiasheng Huang

Xiaolin Li

Yiling Hu

Xuefei Hou

Jiayuan Wu

Affiliations

Soon will be listed here.

Abstract

Background: Myocardial infarction (MI) is a common cardiovascular disease (CVD) in critically ill patients, leading to 17% mortality in the intensive care unit (ICU) setting. Patients with CVD frequently suffer from thiamine insufficiency, thereby thiamine supplements may be helpful. Unfortunately, the relationship between thiamine treatment and survival outcomes in ICU patients with MI is still unknown. The purpose of the research is to demonstrate the survival advantage of thiamine application in these patients.

Methods: The Medical Information Mart of Intensive Care-IV database served as the foundation for this retrospective cohort analysis. Depending on whether patients were given thiamine therapy during the hospital stay, critically ill MI patients were split into the thiamine and non-thiamine groups. The Kaplan-Meier (KM) method and Cox proportional hazard models were used to evaluate the relationship between thiamine use and the risk of in-hospital, 30-day, and 90-day mortality. To validate the results, a 1:2 closest propensity-score matching (PSM) was also carried out.

Results: This study included 1782 patients for analysis with 170 and 1,612 individuals in the thiamine and non-thiamine groups, respectively. The KM survival analyses revealed that the risk of in-hospital, 30-day, and 90-day mortality was significantly lower in the thiamine group than the none-thiamine group. After modifying for a variety of confounding factors, the Cox regression models demonstrated substantial positive impacts of thiamine use on in-hospital, 30-d, and 90-d mortality risk among critically ill patients with MI with hazard ratio being 0.605 [95% confidence interval (CI): 0.397-0.921, = 0.019], 0.618 (95% CI: 0.398-0.960, = 0.032), and 0.626 (95% CI: 0.411-0.953, = 0.028), respectively, in the completely modified model. PSM analyses also obtained consistent results.

Conclusion: Thiamine supplementation is related to a decreased risk of mortality risk in critically ill patients with MI who are admitted to the ICU. More multicenter, large-sample, and well-designed randomized controlled trials are needed to validate this finding.

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References

Aleshin V, Mkrtchyan G, Bunik V . Mechanisms of Non-coenzyme Action of Thiamine: Protein Targets and Medical Significance. Biochemistry (Mosc). 2019; 84(8):829-850. DOI: 10.1134/S0006297919080017. View

Donnino M, Andersen L, Chase M, Berg K, Tidswell M, Giberson T . Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study. Crit Care Med. 2016; 44(2):360-7. PMC: 4754670. DOI: 10.1097/CCM.0000000000001572. View

Carroll I, Mount T, Atkinson D . Myocardial infarction in intensive care units: A systematic review of diagnosis and treatment. J Intensive Care Soc. 2017; 17(4):314-325. PMC: 5624468. DOI: 10.1177/1751143716656642. View

Zhang L, Li S, Lu X, Liu Y, Ren Y, Huang T . Thiamine May Be Beneficial for Patients With Ventilator-Associated Pneumonia in the Intensive Care Unit: A Retrospective Study Based on the MIMIC-IV Database. Front Pharmacol. 2022; 13:898566. PMC: 9259950. DOI: 10.3389/fphar.2022.898566. View

Ohbe H, Matsui H, Yasunaga H . ICU Versus High-Dependency Care Unit for Patients With Acute Myocardial Infarction: A Nationwide Propensity Score-Matched Cohort Study. Crit Care Med. 2022; 50(6):977-985. DOI: 10.1097/CCM.0000000000005440. View

Mitchell A, Ryan T, Gillion A, Wells L, Muthiah M . Vitamin C and Thiamine for Sepsis and Septic Shock. Am J Med. 2019; 133(5):635-638. DOI: 10.1016/j.amjmed.2019.07.054. View

Zhou B, Tian R . Mitochondrial dysfunction in pathophysiology of heart failure. J Clin Invest. 2018; 128(9):3716-3726. PMC: 6118589. DOI: 10.1172/JCI120849. View

DiNicolantonio J, Lavie C, Niazi A, OKeefe J, Hu T . Effects of thiamine on cardiac function in patients with systolic heart failure: systematic review and metaanalysis of randomized, double-blind, placebo-controlled trials. Ochsner J. 2013; 13(4):495-9. PMC: 3865826. View

Eshak E, Arafa A . Thiamine deficiency and cardiovascular disorders. Nutr Metab Cardiovasc Dis. 2018; 28(10):965-972. DOI: 10.1016/j.numecd.2018.06.013. View

10.

Kerns J, Gutierrez J . Thiamin. Adv Nutr. 2017; 8(2):395-397. PMC: 5347104. DOI: 10.3945/an.116.013979. View

11.

Iglesias J, Vassallo A, Patel V, Sullivan J, Cavanaugh J, Elbaga Y . Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis: The ORANGES Trial. Chest. 2020; 158(1):164-173. DOI: 10.1016/j.chest.2020.02.049. View

12.

Moskowitz A, Andersen L, Cocchi M, Karlsson M, Patel P, Donnino M . Thiamine as a Renal Protective Agent in Septic Shock. A Secondary Analysis of a Randomized, Double-Blind, Placebo-controlled Trial. Ann Am Thorac Soc. 2017; 14(5):737-741. PMC: 5427738. DOI: 10.1513/AnnalsATS.201608-656BC. View

13.

Collie J, Greaves R, Jones O, Lam Q, Eastwood G, Bellomo R . Vitamin B1 in critically ill patients: needs and challenges. Clin Chem Lab Med. 2017; 55(11):1652-1668. DOI: 10.1515/cclm-2017-0054. View

14.

Attaluri P, Castillo A, Edriss H, Nugent K . Thiamine Deficiency: An Important Consideration in Critically Ill Patients. Am J Med Sci. 2018; 356(4):382-390. DOI: 10.1016/j.amjms.2018.06.015. View

15.

Hunziker L, Radovanovic D, Jeger R, Pedrazzini G, Cuculi F, Urban P . Twenty-Year Trends in the Incidence and Outcome of Cardiogenic Shock in AMIS Plus Registry. Circ Cardiovasc Interv. 2019; 12(4):e007293. DOI: 10.1161/CIRCINTERVENTIONS.118.007293. View

16.

Kane L, Fang T, Galetta M, Goyal D, Nicholson K, Kepler C . Propensity Score Matching: A Statistical Method. Clin Spine Surg. 2020; 33(3):120-122. DOI: 10.1097/BSD.0000000000000932. View

17.

Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P . Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation. 2017; 136(20):1908-1919. DOI: 10.1161/CIRCULATIONAHA.117.030798. View

18.

Schoenenberger A, Schoenenberger-Berzins R, Auf der Maur C, Suter P, Vergopoulos A, Erne P . Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study. Clin Res Cardiol. 2011; 101(3):159-64. DOI: 10.1007/s00392-011-0376-2. View

19.

Kim W, Jo E, Eom J, Mok J, Kim M, Kim K . Combined vitamin C, hydrocortisone, and thiamine therapy for patients with severe pneumonia who were admitted to the intensive care unit: Propensity score-based analysis of a before-after cohort study. J Crit Care. 2018; 47:211-218. DOI: 10.1016/j.jcrc.2018.07.004. View

20.

Damluji A, van Diepen S, Katz J, Menon V, Tamis-Holland J, Bakitas M . Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association. Circulation. 2021; 144(2):e16-e35. PMC: 9364424. DOI: 10.1161/CIR.0000000000000985. View