Patterns of Death in Patients with Sepsis and the Use of Hydrocortisone, Ascorbic Acid, and Thiamine to Prevent These Deaths

Surg Infect (Larchmt). Nov/Dec 2018;19(8):812-820. doi: 10.1089/sur.2018.111. Epub 2018 Jul 24.


Background: In general, patients with sepsis die from the host response to the infecting pathogen rather than from the infecting pathogen itself. Four patterns of death have been identified in sepsis, namely vasoplegic shock, single-organ respiratory failure (acute respiratory distress syndrome [ARDS]), multi-system organ failure (MSOF), and persistent MSOF with ongoing inflammation and immunosuppression with recurrent infections (persistent inflammation-immunosuppression and catabolism syndrome [PICS]). To improve the outcome of sepsis adjunctive therapies that modulate the immune system have been tested; these therapies that have targeted specific molecules or pathways have universally failed. Conclusion: We propose that the combination of hydrocortisone, intravenous ascorbic acid, and thiamine (HAT therapy), which synergistically targets multiple pathways, restores the dysregulated immune system and organ injury, and reduces the risk of death and organ failure following sepsis.

Keywords: hydrocortisone; multi-system organ failure; sepsis; thiamine; vitamin C.

Publication types

  • Review

MeSH terms

  • Ascorbic Acid / therapeutic use*
  • Drug Therapy, Combination / methods*
  • Humans
  • Hydrocortisone / therapeutic use*
  • Immunologic Factors / therapeutic use*
  • Sepsis / drug therapy*
  • Sepsis / mortality*
  • Thiamine / therapeutic use*
  • Treatment Outcome


  • Immunologic Factors
  • Ascorbic Acid
  • Hydrocortisone
  • Thiamine