Objectives: The post-sepsis syndrome characterized by the development of new psychiatric
and cognitive deficits occurs in approximately 50% of sepsis survivors. This paper reviews the
potential role of glucocorticoids, vitamin C and thiamine in limiting the development of the postsepsis
Data Sources and Study Selection: A PubMed literature review was performed for relevant articles.
Only articles in English that studied sepsis were included.
Data Extraction and Data Synthesis: Vitamin C is concentrated almost 100-fold in neurons and is
the major antioxidant in the brain. Vitamin C deficiency is almost universal in patients with sepsis
and increases cerebral oxidant injury, which has been linked to the development of delirium.
Furthermore, vitamin C plays an essential role in the synthesis of neurotransmitters and in
neuromodulation. Similarly, thiamine deficiency is common in sepsis and thiamine deficiency is well
established to be associated with memory and cognitive dysfunction. Glucocorticoids play a central
role in the adaptive response to stress, with exogenous glucocorticoid therapy having a proven role in
reducing acute delirium and post-traumatic stress syndrome.
Conclusion: We postulate that the treatment of severe sepsis with the combination of vitamin C,
hydrocortisone and thiamine in addition to improving the short-term outcome of sepsis may reduce
the development of the post-sepsis syndrome.
Keywords: Vitamin C, sepsis, anti-oxidant, delirium, cognitive dysfunction, thiamine, hydrocortisone, corticosteroid
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