Efficacy and safety of vitamin C for atrial fibrillation after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials

Hu, Xiaolan; Yuan, Linhui; Wang, Hongtao; Li, Chang; Cai, Jing; Hu, Yanhui; Ma, Cheng

doi:10.1016/j.ijsu.2016.12.009

Cited by 48 publications

(46 citation statements)

References 33 publications

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“…Several meta‐analyses on this issue also confirmed the preventive role of vitamin C on POAF (see Supporting Information, Table S4, in the online version of this article). However, subgroup or sensitivity analyses were not performed in most of them, and cohort studies were included in the study by Polymeropoulos et al Non‐RCTs were treated as RCTs and involved for meta‐analysis in 3 meta‐analyses, and study of noncardiac surgery was analyzed in the study by Hemilä et al…”

Section: Discussionsupporting

confidence: 56%

“…Numerous pharmacologic interventions attempt to reduce the incidence of POAF; all of them have limitations and adverse effects . It is reported that vitamin C is a promising and cost‐effective prophylactic therapy for POAF, and several meta‐analyses of randomized controlled trials (RCTs) of vitamin C for arrhythmia prophylaxis have been published . Though they all demonstrated that vitamin C could reduce the incidence of POAF, the study design and quality of included studies are poor.…”

Section: Introductionmentioning

confidence: 99%

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Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Shi

Chen

et al. 2018

Clinical Cardiology

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We undertook a systematic review and meta-analysis to evaluate the effect of vitamin C supplementation (vitamin C solely or as adjunct to other therapy) on prevention of postoperative atrial fibrillation (POAF) in patients after cardiac surgery. PubMed, Embase, Web of Science, and Cochrane Library were systematically searched to identify randomized controlled trials assessing the effect of vitamin C supplementation in adult patients undergoing cardiac surgery, and the meta-analysis was performed with a random-effects model. Thirteen trials involving 1956 patients were included. Pooling estimate showed a significantly reduced incidence of POAF (relative risk [RR]: 0.68, 95% confidence interval [CI]: 0.54 to 0.87, P = 0.002) both in vitamin C alone (RR: 0.75, 95% CI: 0.63 to 0.90, P = 0.002) and as an adjunct to other therapy (RR: 0.32, 95% CI: 0.20 to 0.53, P < 0.001). The results remain stable and robust in subgroup and sensitivity analyses, and trial sequential analysis also confirmed that the evidence was sufficient and conclusive. Additionally, vitamin C could significantly decrease intensive care unit length of stay (weighted mean difference: -0.24 days, 95% CI: -0.45 to -0.03, P = 0.023), hospital length of stay (weighted mean difference: -0.95 days, 95% CI: -1.64 to -0.26, P = 0.007), and risk of adverse events (RR: 0.45, 95% CI: 0.21 to 0.96, P = 0.039). Use of vitamin C alone and as adjunct to other therapy can prevent POAF in patients undergoing cardiac surgery and should be recommended for patients receiving cardiac surgery for prevention of POAF.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Shi

Chen

et al. 2018

Clinical Cardiology

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“…Regarding atrial fibrillation, our results confirm the results of other meta-analyses [12,13,14,15], who all found a significant beneficial effect of vitamin C. None of the other meta-analyses assessed organ dysfunctions other than atrial fibrillation, but Shi et al found significantly fewer adverse events in patients receiving vitamin C [15]. …”

Section: Discussionsupporting

confidence: 88%

“…Four meta-analyses also found significantly shorter hospital-LOS associated with vitamin C [11,15,39,40]. However, Hu et al performed a meta-analysis where vitamin C administration was not associated with reductions in either ICU- or hospital-LOS [14]. …”

Section: Discussionmentioning

confidence: 99%

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Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ-protective micronutrient. Past clinical trials and meta-analyses have focused predominantly on occurrence of postoperative atrial fibrillation. Therefore, we investigated the influence of perioperative vitamin C administration on clinically relevant parameters closer related to the patient’s recovery, especially organ function, and overall outcomes after cardiac surgery. Methods: Randomized controlled trials (RCTs) comparing perioperative vitamin C administration versus placebo or standard of care in adult patients undergoing cardiac surgery were identified through systematic searches in Pubmed, EMBASE, and CENTRAL on 23 November 2018. Published and unpublished data were included. Assessed outcomes include organ function after cardiac surgery, adverse events, in-hospital mortality, intensive care unit, and hospital length-of-stay. Data was pooled only when appropriate. Results: A total of 19 RCTs with 2008 patients were included in this meta-analysis. Vitamin C significantly decreased the incidence of atrial fibrillation (p = 0.008), ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and hospital length-of-stay (p < 0.0001). However, on average, vitamin C had no significant effects on in-hospital mortality (p = 0.76), or on the incidence of stroke (p = 0.82). High statistical heterogeneity was observed in most analyses. Conclusions: Vitamin C impacts clinically and economically important outcomes, such as ICU and hospital length-of-stay, duration of mechanical ventilation and lowers the incidence of atrial fibrillation. Due to missing reports on organ dysfunction, this meta-analysis cannot answer the question, if vitamin C can improve single- or multiorgan function after cardiac surgery.

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History of scurvy and use of vitamin C in critical illness: A narrative review

et al. 2022

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In 1747, an important milestone in the history of clinical research was set, as the Scottish surgeon James Lind conducted the first randomized controlled trial. Lind was interested in scurvy, a severe vitamin C deficiency which caused the death of thousands of British seamen. He found that a dietary intervention with oranges and lemons, which are rich in vitamin C by nature, was effective to recover from scurvy. Because of its antioxidative properties and involvement in many biochemical processes, the essential micronutrient vitamin C plays a key role in the human biology. Moreover, the use of vitamin C in critical illness-a condition also resulting in death of thousands in the 21st century-has gained increasing interest, as it may restore vascular responsiveness to vasoactive agents, ameliorate microcirculatory blood flow, preserve endothelial barriers, augment bacterial defense, and prevent apoptosis. Because of its redox potential and powerful antioxidant capacity, vitamin C represents an inexpensive and safe antioxidant, with the potential to modify the inflammatory cascade and improve clinical outcomes of critically ill patients. This narrative review aims to update and provide an overview on the role of vitamin C in the human biology and in critically ill patients, and to summarize current evidence on the use of vitamin C in diverse populations of critically ill patients, in specific focusing on patients with sepsis and coronavirus disease 2019.

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Efficacy and safety of vitamin C for atrial fibrillation after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials

Cited by 48 publications

References 33 publications

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

History of scurvy and use of vitamin C in critical illness: A narrative review

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