Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit: a preliminary study

Abstract

Background Critically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia. Methods Eighty critically ill patients with pneumonia were enrolled in this randomized double-blinded clinical trial. Patients with a CURB-65 score > 3, one major criterion, or ≥ 3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as a continuous infusion or normal saline in the same volume correspondingly for 96 h. Serum levels of vitamin C were noted at baseline and 48 h after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2, and mortality rate were noted for all patients till the 28th day. Any complications related to the vitamin C administration were recorded. Results Duration of mechanical ventilation and vasopressor use were significantly lower in the intervention group (p: < 0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have a significant difference but its levels increased in the intervention group and decreased in the control group during the study period. Mortality rate insignificantly decreased in the intervention group (p = 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C. Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation, and vasopressor use without any significant effect on mortality. Trial registration: IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, Seied Hadi Saghaleini.

Intravenous vitamin C administration to patients with septic shock: a pilot randomised controlled trial

“…Two other trials administered intravenous vitamin C at a dose of 6 g/day and also reported a significant decrease in duration of vasopressors (55 vs 156 h, p = 0.001, and 26 vs 44 h, p < 0.05) [ 8 , 9 ]. Another trial administered 60 mg/kg/day vitamin C as a continuous infusion to critically ill patients with pneumonia and reported a decrease in vasopressor use from 82 to 55 h (p = 0.003) [ 10 ]. Further RCTs that have used vitamin C in combination with hydrocortisone and/or thiamine have also reported improvements in vasopressor requirements [ 27 – 29 ].…”

“…Since the publication of several early trials indicating possible beneficial effects of intravenous vitamin C in critically ill patients with sepsis and septic shock, as monotherapy [ 4 , 5 ] and in combination with thiamine and hydrocortisone [ 6 ], there has been an upsurge in clinical trials investigating its potential benefits in these patients [ 7 ]. Various trials administering intravenous vitamin C to patients with sepsis and septic shock have indicated decreased vasopressor requirements [ 5 , 8 – 10 ], improved sequential organ failure assessment (SOFA) scores [ 4 , 9 ], decreased ICU length of stay [ 8 , 11 ], and decreased mortality [ 5 , 9 , 11 ]. However, some trials showed no effects of vitamin C intervention on SOFA scores [ 11 ], ICU length of stay [ 5 ], or mortality [ 8 , 10 ], so the evidence is currently mixed with regard to these outcomes.…”

“…Various trials administering intravenous vitamin C to patients with sepsis and septic shock have indicated decreased vasopressor requirements [ 5 , 8 – 10 ], improved sequential organ failure assessment (SOFA) scores [ 4 , 9 ], decreased ICU length of stay [ 8 , 11 ], and decreased mortality [ 5 , 9 , 11 ]. However, some trials showed no effects of vitamin C intervention on SOFA scores [ 11 ], ICU length of stay [ 5 ], or mortality [ 8 , 10 ], so the evidence is currently mixed with regard to these outcomes. Since the emergence of severe coronavirus disease in 2019 (COVID-19), research into the potential treatments of sepsis, a major complication of severe COVID-19, has become even more important.…”

Defining Sepsis Phenotypes—Two Murine Models of Sepsis and Machine Learning

“…And the second is that similar sources of infection may drive starkly different inflammatory responses across otherwise similar appearing hosts. The failure of the current definition of sepsis may explain the discordance of multiple clinical trials, by not accounting for differences in the innate immune response across patients and invoked immune response across multiple etiologies of infection (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). We propose a simple hypothesis: not all sepsis is the same even in animal models.…”

Therapies to Prevent Progression of COVID-19, Including Hydroxychloroquine, Azithromycin, Zinc, and Vitamin D3 With or Without Intravenous Vitamin C: An International, Multicenter, Randomized Trial

“…In addition, intravenous vitamin C (IVC) has known immune-stimulating and antiviral properties [14] and had shown promise as a treatment for acute respiratory syndrome and pneumonia [15]. Recent studies reported on the benefits of IVC therapy for COVID-19 [16,17].…”