Effect of Thiamine Supplementation on Mortality in Septic Patients: A Meta-Analysis of Randomized Controlled Trials

Background Sepsis is a life-threatening condition characterized by a dysregulated host response to infection and leads to high mortality rates. Thiamine has been proposed as a potential therapeutic agent in sepsis. However, the effect of thiamine on mortality in septic patients remains inconclusive. Existing trials on thiamine's efficacy in sepsis show conflicting results, necessitating a comprehensive meta-analysis. Objective This meta-analysis aims to evaluate the impact of thiamine supplementation on mortality, sequential organ failure assessment (SOFA) scores and the likelihood of requiring renal replacement therapy (RRT) in patients with sepsis. Methods We systematically searched PubMed, Embase, Web of Science, CNKI, and the Cochrane Library for randomized, double-blind, controlled trials up to October 2024. The mortality rate, SOFA scores and the probability of requiring RRT in patients with sepsis were assessed. Results Thiamine supplementation did not significantly reduce overall mortality of patients with sepsis compared to placebo ( RR  = 1.10, 95% CI : 0.89–1.37, P  = 0.38). Similarly, thiamine showed no significant effect on SOFA scores ( SMD = -0.69, 95% CI : -1.63-0.25, P  = 0.15). However, in septic patients with baseline thiamine deficiency, thiamine supplementation significantly reduced 28-day mortality ( RR  = 0.70, 95% CI : 0.52–0.90, P  = 0.01). Additionally, thiamine reduced the probability of requiring RRT ( RR  = 0.75, 95% CI : 0.61–0.93, P  = 0.001). Conclusion Thiamine supplementation could reduce the need for RRT and did not reduce overall mortality of patients with sepsis. However, thiamine supplementation offers survival benefits in patients with baseline thiamine deficiency.