Background: Thiamine is a vitamin that plays a role in lactate clearance. Patients with sepsis may present with elevated lactate, and also in cirrhosis, as lactate is hepatically metabolized. Prior studies showed mixed results regarding the role of thiamine for lactate clearance with limited inclusion of cirrhosis patients. The purpose of this study was to determine the association of high-dose intravenous thiamine on time to lactate clearance among patients with cirrhosis and sepsis. Methods: We performed a single-center retrospective cohort study of critically ill patients with cirrhosis with a diagnosis of sepsis with lactate >4 mmol/L between January 1, 2020, and December 31, 2024. Patients who received ≥400 mg were classified as receiving high-dose thiamine. Fine-Gray competing risks models adjusted for demographic, comorbidity, and illness severity variables estimated the association of receiving high-dose thiamine with time to lactate clearance, defined as a lactate <3 mmol/L. Additional secondary outcomes included intensive care unit and in-hospital mortality. Results: A total of 136 patients were identified and included in the analysis. Median age was 58.4, and 54% were male. Thirty-three patients received high-dose thiamine. Patients had similar baseline characteristics, including on indicators of illness severity, cirrhosis severity, and use of vasopressors. In both unadjusted and adjusted models, the receipt of high-dose thiamine was not associated with differences in time to lactate clearance or mortality. Conclusions: Thiamine use in patients with cirrhosis who experienced sepsis did not result in improved lactate clearance compared to those who did not receive high-dose thiamine. These data do not support empiric high-dose thiamine to aid lactate clearance in this population.
Ali et al. (Wed,) studied this question.