Relationship between Adjuvant Thiamine, Ascorbic Acid, and Combinations of These Drugs with Reducing the Incidence, Increasing MMP-9/TIMP-1 Ratio, and Decreasing Score Sofa in Mechanically Ventilated Patients with Severe Sepsis or Septic Shock

A high number of sepsis patients demand all health institutions to provide adequate treatment and management. Several therapeutic agents are developed as adjuvants for handling sepsis cases. Ascorbic acid and thiamine are the potential to be intensively studied for their benefits in decreasing the sepsis rate. This is a retrospective cohort analytic research carried out at Haji Adam Malik General Hospital. Blood tests are conducted at the Integrated Laboratory of the Faculty of Medicine, Universitas Sumatera Utara. This research is conducted for 12 months. There are 147 septic patients divided into four groups (NaCl, thiamine, ascorbic acid, and combined groups). The parameters measured are the enzymes of MMP-9 of TIMP-1. A propensity score analysis is performed to obtain homogeneous patients. There are 25 patients within each group. It can be seen that the combination of ascorbic acid and thiamine on the incidence rate performs an odds ratio of 1.19 (0.37-3.8) at 95% CI. However, a single administration of ascorbic acid can significantly reduce the incidence rate by 0.4 times and 0.67 times in the thiamine single group compared with the control group. In the combination of ascorbic acid and thiamine to the MMP-9/TIMP-1 ratio, the odds ratio is 0.34 (0.09-1.30) at 95% CI. The administration of single ascorbic acid and thiamine alone can also reduce the MMP-9/TIMP-1. Meanwhile, the combination of ascorbic acid and thiamine on SOFA scores results in an odds ratio of 2.66 (0.85-8.36) at 95% CI. For single ascorbate and single thiamine, each performs 1.38 (0.45-2, 24) and 1.17 (0.38-3.83) at 95% CI. Combination therapy of vitamin C and thiamine does not improve treatment outcomes. Thiamine and ascorbate alone showed better benefits compared with the combination therapy viewed from the incidence rate, MMP-9/TIMP-1 ratio, and SOFA score.