Журнал «Медицина неотложных состояний» Том 22, №6, 2026

Актуальність. Комбіноване застосування гідрокортизону, аскорбінової кислоти й тіаміну (терапія ГАТ) тривалий час розглядалося як патогенетично обґрунтований допоміжний метод лікування сепсису та септичного шоку. Очікуваний ефект ґрунтувався на здатності цих компонентів зменшувати вазоплегію, ендотеліальну дисфункцію, оксидативний стрес, а також коригувати мікроциркуляторні порушення та мітохондріальну недостатність. Водночас результати клінічних випробувань на сьогодні є суперечливими. Мета: узагальнити сучасні дані щодо біологічного обґрунтування, клінічної ефективності й обмежень терапії ГАТ, а також визначити перспективи її застосування з урахуванням індивідуальних фенотипів пацієнтів із сепсисом. Матеріали та методи. Здійснено аналіз фахової літератури в базах даних PubMed, Scopus і Google Scholar. Джерела класифіковано за дизайном досліджень, складом терапії, характеристиками пацієнтів, термінами початку втручання та ключовими клінічними показниками. Результати. Перші спостережні й механістичні дослідження підтверджували доцільність застосування терапії ГАТ, вказуючи на послаблення оксидативного стресу, стабілізацію ендотеліального бар’єра, поліпшення гемодинаміки та зниження потреби у вазопресорах. Проте подальші рандомізовані контрольовані випробування не продемонстрували стабільного зниження рівня летальності в загальній популяції хворих. Найбільш значущим клінічним результатом є не виживаність, а швидше виведення пацієнтів зі стану шоку, скорочення тривалості вазопресорної підтримки й можливе зменшення вираженості органної дисфункції. Ефективність методу, імовірно, визначається часом початку лікування, складом базової терапії, вихідною тяжкістю стану, наявністю дефіциту вітамінів, а також особливостями запального профілю і ступенем вазоплегії. Отримані дані вказують на те, що такий підхід є перспективним для окремих груп пацієнтів, а не для рутинного застосування. Висновки. Терапія ГАТ не є універсальним стандартом лікування сепсису. Проте вона залишається важливою моделлю переходу від емпіричного метаболічного відновлення до персоналізованої допоміжної терапії, що базується на виокремленні специфічних фенотипів захворювання.

Background. The combined use of hydrocortisone, ascorbic acid, and thiamine (HAT therapy) has long been considered a pathogenetically sound adjunctive treatment for sepsis and septic shock. The expected effect was based on the ability of these components to reduce vasoplegia, endothelial dysfunction, and oxidative stress, as well as to correct microcirculatory disorders and mitochondrial failure. However, clinical trial results currently remain controversial. Objective: to summarize current data on the biological rationale, clinical efficacy, and limitations of HAT therapy, as well as to determine the prospects for its use, taking into account the individual phenotypes of patients with sepsis. Materials and methods. An analysis of professional literature was conducted using the PubMed, Scopus, and Google Scholar databases. Sources were classified by study design, therapy composition, patient characteristics, timing of intervention, and key clinical outcomes. Results. Initial observational and mechanistic studies supported the feasibility of HAT therapy, pointing to reduced oxidative stress, stabilization of the endothelial barrier, improved hemodynamics, and a decreased requirement for vasopressors. However, subsequent randomized controlled trials failed to demonstrate a consistent reduction in mortality rates within the general patient population. The most significant clinical outcome appears to be faster shock reversal and a reduction in the duration of vasopressor support alongside a potential decrease in the severity of organ dysfunction, rather than overall survival. The efficacy of the method is likely determined by the timing of treatment initiation, the composition of baseline therapy, initial severity of illness, the presence of vitamin deficiencies, as well as specific inflammatory profiles and the degree of vasoplegia. The findings suggest that this approach is promising for specific patient subgroups rather than for routine application. Conclusions. HAT therapy is not a universal standard of care for sepsis. However, it remains an important model for the transition from empirical metabolic resuscitation to personalized adjunctive therapy based on the identification of specific disease phenotypes.

сепсис; септичний шок; терапія ГАТ; метаболічна підтримка; персоналізована медицина; огляд

sepsis; septic shock; HAT therapy; metabolic support; personalized medicine; review

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