Usefulness of Antioxidants as Adjuvant Therapy for Septic Shock: A Randomized Clinical Trial
Alfredo Aisa-Alvarez,
María Elena Soto,
Verónica Guarner-Lans,
Gilberto Camarena-Alejo,
Juvenal Franco-Granillo,
Enrique A. Martínez-Rodríguez,
Ricardo Gamboa Ávila,
Linaloe Manzano Pech,
Israel Pérez-Torres
Affiliations
Alfredo Aisa-Alvarez
Critical Care Department, American British Cowdray (ABC) Medical Center, I.A.P. ABC Sur 136 No. 116 Col. las Américas, Mexico City 01120, Mexico
María Elena Soto
Critical Care Department, American British Cowdray (ABC) Medical Center, I.A.P. ABC Sur 136 No. 116 Col. las Américas, Mexico City 01120, Mexico
Verónica Guarner-Lans
Physiology Department Instituto Nacional de Cardiología Ignacio Chávez. Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
Gilberto Camarena-Alejo
Critical Care Department, American British Cowdray (ABC) Medical Center, I.A.P. ABC Sur 136 No. 116 Col. las Américas, Mexico City 01120, Mexico
Juvenal Franco-Granillo
Critical Care Department, American British Cowdray (ABC) Medical Center, I.A.P. ABC Sur 136 No. 116 Col. las Américas, Mexico City 01120, Mexico
Enrique A. Martínez-Rodríguez
Critical Care Department, American British Cowdray (ABC) Medical Center, I.A.P. ABC Sur 136 No. 116 Col. las Américas, Mexico City 01120, Mexico
Ricardo Gamboa Ávila
Physiology Department Instituto Nacional de Cardiología Ignacio Chávez. Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
Linaloe Manzano Pech
Cardiovascular Biomedicine Department Instituto Nacional de Cardiología Ignacio Chávez. Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
Israel Pérez-Torres
Cardiovascular Biomedicine Department Instituto Nacional de Cardiología Ignacio Chávez. Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
Background and objectives: Oxidative stress (OS) participates in the pathophysiology of septic shock, which leads to multiple organ failure (MOF), ischemia-reperfusion injury, and acute respiratory distress syndrome. Therefore, antioxidants have been proposed as therapy. Here, we evaluated the effect of antioxidant treatments in patients with septic shock with MOF and determined levels OS before and after treatment. This study was a randomized, controlled, triple-masked, and with parallel assignment clinical trial with a control group without treatment. Materials and Methods: It included 97 patients of either sex with septic shock. 5 treatments were used each in an independent group of 18 patients. Group 1 received vitamin C (Vit C), group 2 vitamin E (Vit E), group 3 n-acetylcysteine (NAC), group 4 melatonin (MT), and group 5 served as control. All antioxidants were administered orally or through a nasogastric tube for five days as an adjuvant to the standard therapy. Results: The results showed that all patients presented MOF due to sepsis upon admission and that the treatment decreased it (p = 0.007). The antioxidant treatment with NAC increased the total antioxidant capacity (p p p = 0.04). Procalcitonin levels were reduced by Vit E (p = 0.04), NAC (p = 0.001), and MT (p = 0.04). Lipid-peroxidation was reduced in patients that received MT (p = 0.04). Conclusions: In conclusion, antioxidant therapy associated with standard therapy reduces MOF, OS, and inflammation in patients with septic shock.
