Editing Sepsis (section)

==Research==
[[File:Sepsis fig.png|thumb|Phenotypic strategy switches of microbes capable of provoking sepsis]]
Some authors suggest that initiating sepsis by the normally [[Mutualism (biology)|mutualistic]] (or neutral) members of the [[microbiome]] may not always be an accidental side effect of the deteriorating host immune system. Rather it is often an [[Adaptive behavior|adaptive]] microbial response to a sudden decline of host survival chances. Under this scenario, the microbe species provoking sepsis benefit from monopolizing the future cadaver, utilizing its biomass as [[decomposer]]s, and then transmitting through soil or water to establish mutualistic relations with new individuals. The bacteria ''[[Streptococcus pneumoniae]]'', ''[[Escherichia coli]]'', ''[[Proteus (bacterium)|Proteus]]'' spp., ''[[Pseudomonas aeruginosa]]'', ''[[Staphylococcus aureus]]'', ''[[Klebsiella]]'' spp., ''[[Clostridium]]'' spp., ''[[Lactobacillus]]'' spp., ''[[Bacteroides]]'' spp. and the fungi ''[[Candida (fungus)|Candida]]'' spp. are all capable of such a high level of [[phenotypic plasticity]]. Not all cases of sepsis arise through such adaptive microbial strategy switches.<ref name=Rozsa2017/>

[[Paul E. Marik]]'s "Marik protocol", also known as the "HAT" protocol, proposed a combination of [[hydrocortisone]], [[vitamin C]], and [[thiamine]] as a treatment for preventing sepsis for people in [[intensive care]]. Marik's initial research, published in 2017, showed dramatic evidence of benefit, leading to the protocol becoming popular among intensive care physicians, especially after the protocol received attention on social media and [[National Public Radio]], leading to criticism of [[science by press conference]] from the wider medical community. Subsequent independent research failed to replicate Marik's positive results, indicating the possibility that they had been compromised by bias.<ref name=jama>{{cite journal | vauthors = Rubin R | title = Wide Interest in a Vitamin C Drug Cocktail for Sepsis Despite Lagging Evidence | journal = JAMA | volume = 322 | issue = 4 | pages = 291–293 | date = July 2019 | pmid = 31268477 | doi = 10.1001/jama.2019.7936 | s2cid = 195788169 }}</ref> A [[systematic review]] of trials in 2021 found that the claimed benefits of the protocol could not be confirmed.<ref>{{cite journal | vauthors = Lee YR, Vo K, Varughese JT | title = Benefits of combination therapy of hydrocortisone, ascorbic acid and thiamine in sepsis and septic shock: A systematic review | journal = Nutrition and Health | volume = 28 | issue = 1 | pages = 77–93 | date = March 2022 | pmid = 34039089 | doi = 10.1177/02601060211018371 | s2cid = 235215735 }}</ref>

Overall, the evidence for any role of vitamin C in the treatment of sepsis remains unclear {{as of|lc=yes|2021}}.<ref>{{cite journal | vauthors = Li YR, Zhu H | title = Vitamin C for sepsis intervention: from redox biochemistry to clinical medicine | journal = Molecular and Cellular Biochemistry | volume = 476 | issue = 12 | pages = 4449–4460 | date = December 2021 | pmid = 34478032 | pmc = 8413356 | doi = 10.1007/s11010-021-04240-z }}</ref>