Dtsch Med Wochenschr 2018; 143(20): 1450-1454
DOI: 10.1055/a-0661-1112
Klinischer Fortschritt
Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Spielen Vitamine bei der Pathogenese und Therapie der Sepsis eine Rolle?

Do Vitamins Play a Role in the Pathogenesis and Therapy of Sepsis?
Ulrich Häussler
1   Department Innere Medizin, Internistische Intensivstation, Universität Tübingen
2   Department Innere Medizin, Abteilung für Gastroenterologie, Hepatologie und Infektionskrankheiten, Universität Tübingen
,
Reimer Riessen
1   Department Innere Medizin, Internistische Intensivstation, Universität Tübingen
,
Michael Haap
1   Department Innere Medizin, Internistische Intensivstation, Universität Tübingen
› Author Affiliations
Further Information

Publication History

Publication Date:
04 October 2018 (online)

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Was ist neu?

Vitamin B1 (= Thiamin) Beim septischen Schock weisen erste Studien mit relativ kleinen Fallzahlen auf positive Effekte einer frühzeitigen Vitamin-B1-/Thiamin-Substitution in Bezug auf Laktatclearance, Nierenfunktion und Letalität, insbesondere bei Patienten mit Thiaminmangel hin. Da ein Thiaminmangel bei Intensivpatienten häufig ist, sollte eine Thiamin-Substitution in ausreichender Dosierung bei allen Sepsispatienten mit Laktatazidose erwogen werden.

Vitamin C Vitamin C besitzt multiple biologische Funktionen, die sich im Rahmen einer Sepsis günstig auswirken könnten. Die Applikation von hochdosiertem Vitamin C in Kombination mit Thiamin und Hydrokortison war in einer viel diskutierten, 2017 veröffentlichten klinischen Studie mit einer drastischen Senkung der Sepsisletalität assoziiert. In mehreren prospektiven randomisierten Studien wird die Wirksamkeit dieses Therapiekonzepts derzeit unabhängig voneinander überprüft.

Vitamin D Auch der Einsatz von Vitamin D3 bei der Sepsis ist aus pathophysiologischer Sicht insbesondere bei Mangelzuständen ein vielversprechender Ansatz, allerdings ist der Wert einer therapeutischen Substitution derzeit noch nicht gesichert.

Abstract

Hospital mortality of severe sepsis and septic shock is still around 40 % according to recent studies. In accordance to the current sepsis definition, sepsis is a life-threatening organ dysfunction caused by a dysregulated response of the organism to infection. Septic shock is defined by vasopressor-dependent circulatory failure and lactic acidosis. Patients with sepsis and septic shock are often old and/or characterized by severe comorbidities, e. g. tumor or liver disease. These factors also predispose to malnutrition and hence to a corresponding deficiency of essential nutritional components e. g. vitamins. A number of recent studies and reviews have addressed the question whether deficiencies in certain vitamins may facilitate the transition from infection to septic shock. In addition, studies have investigated the effect of high-dose vitamin therapies on sepsis mortality and sepsis-associated organ dysfunctions. This article would like to summarize this current discussion with a focus on vitamin B1 (thiamine), vitamin C and vitamin D.

Schlüsselwörter

Sepsis - Thiamin - Vitamin C - Vitamin D

Key words

sepsis - thiamine - vitamin C - vitamin D
 

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