Intravenous vitamin C in adults with sepsis in the intensive care unit: still LOV’IT?

Stoppe, Christian; Preiser, Jean-Charles; Backer, Daniel De; Elke, Gunnar

doi:10.1186/s13054-022-04106-w

Cited by 11 publications

(12 citation statements)

References 16 publications

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“…the severity of illness heterogeneity of the cohorts is a characteristic and a weakness of the large RCTs. As already pointed by some, the IVVC patients tended to be sicker 2 , overall contributing to the higher risk of organ dysfunction…”

mentioning

confidence: 59%

“…the severity of illness heterogeneity of the cohorts is a characteristic and a weakness of the large RCTs. As already pointed by some, the IVVC patients tended to be sicker [2], overall contributing to the higher risk of organ dysfunction 3. the vitamin C status at start: Figure 3 shows some surprising levels of vitamin C, raising the question of the validity of the measures. The very high blood levels in the 4th quartile are not consistent with sepsis as during inflammation ascorbic acid levels drop steeply as soon as C-reactive protein exceeds 10 mg/l [13].…”

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confidence: 71%

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Kommentar zu „Intravenöse Vitamin C-Gabe: 28-Tage-Ergebnis septischer Patienten verschlechtert?“

2022

Aktuelle Ernährungsmedizin

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Rarely the results of a study were expected so eagerly as the LOVIT trial, an acronym for “Lessening Organ Dysfunction with Vitamin C” 1. This blinded multicentric randomised trial (RCT) is a well-performed study 1 testing high-dose intravenous vitamin C (IVVC) (50 mg/kg every 6 h for 96hrs). With 872 patients, the trial is the largest so far. The results are sobering, as the patients receiving IVVC had a worse primary composite outcome compared to the placebo group: of note, the different components of the outcome (death or persistent organ dysfunction), did not differ significantly when considered individually 2.

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confidence: 59%

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confidence: 71%

Kommentar zu „Intravenöse Vitamin C-Gabe: 28-Tage-Ergebnis septischer Patienten verschlechtert?“

2022

Aktuelle Ernährungsmedizin

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“…[95][96][97] An updated SRMA 98 including the results of the LOVIT trial 94 demonstrated beneficial effects of vitamin C on 30-day and hospital mortality in 4366 patients, whereas an adverse effect was observed at day 90 in an analysis including only a subset of 1722 patients and for which LOVIT contributed to 58%. 99 Taken together, a strong signal of benefit for high-dose vitamin C was detected across four SRMAs published last year. 100 Yet there appears to be no consistent evidence supporting the routine use of high-dose vitamin C in critically ill patients with sepsis alone or in combination with steroids or thiamin.…”

Section: Latest Studies On Micronutrients In the Critically Illmentioning

confidence: 90%

What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023: A narrative review

et al. 2023

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Medical nutrition therapy (MNT) represents an essential element in the medical care of critically ill patients admitted to an intensive care unit (ICU).Increasing awareness exists that energy and nutrients not only preserve body structures such as lean body/muscle mass but also represent promising therapeutic elements to target the profound metabolic, inflammatory, endocrinologic, and immunologic alterations occurring during critical illness.However, despite intense research activities for years, diverse aspects of MNT such as the optimal timing, dosing, and composition of energy and macronutrient supply, as well as the role of micronutrients, are still an issue of debate resulting from strong heterogeneity in methods and findings of respective studies. These discrepancies are also reflected in diverging recommendations of international clinical nutrition guidelines for specific topics. In addition, implementing targeted, personalized MNT strategies in routine clinical practice underlies difficulties and challenges resulting from disease-specific issues and/or organizational, structural, and educational aspects. This narrative review aims to summarize the most recent evidence relevant to clinical practice on selected aspects of MNT in adult patients in the ICU and to provide guidance for implementing evidence-based approaches for adequate energy and nutrient supply in the ICU setting.

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“…However, this year, in a large randomized controlled trial, the “LOVIT- trial” from Lamontagne et al, vitamin C monotherapy in septic patients was associated with a significantly higher occurrence of the combined endpoint: “death + persistent organ dysfunction,” while the latter was defined as use of vasopressors, invasive mechanical ventilation, or new renal-replacement therapy at 28 days ( 128 ). Although this study with 872 patients led to doubts regarding the potential benefits of vitamin C, it should be mentioned that neither the single components of the composite endpoint nor inflammatory markers, nor 6 months-mortality nor quality of life were different between the groups and that the severity of illness was unevenly balanced, so that a null effect rather a harmful is currently discussed ( 129 ). In addition, commencement of vitamin C therapy was delayed (>10 h) and with high variance, limiting the generalizability of the findings.…”

Section: Vitamin Cmentioning

confidence: 99%

An update of the effects of vitamins D and C in critical illness

Hill

Starchl²,

Dresen³

et al. 2023

Front. Med.

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Many critically ill patients are vitamin D and vitamin C deficient and the current international guidelines state that hypovitaminoses should be compensated. However, uncertainty about optimal dosage, timing and indication exists in clinical routine, mainly due to the conflicting evidence. This narrative review discusses both micronutrients with regards to pathophysiology, clinical evidence of benefits, potential risks, and guideline recommendations. Evidence generated from the most recent clinical trials are summarized and discussed. In addition, pragmatic tips for the application of these vitamins in the clinical routine are given. The supplementations of vitamin D and C represent cost-effective and simple interventions with excellent safety profiles. Regarding vitamin D, critically ill individuals require a loading dose to improve 25(OH)D levels within a few days, followed by a daily or weekly maintenance dose, usually higher doses than healthy individuals are needed. For vitamin C, dosages of 100–200 mg/d are recommended for patients receiving parenteral nutrition, but needs may be as high as 2–3 g/d in acutely ill patients.

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Intravenous vitamin C in adults with sepsis in the intensive care unit: still LOV’IT?

Cited by 11 publications

References 16 publications

Kommentar zu „Intravenöse Vitamin C-Gabe: 28-Tage-Ergebnis septischer Patienten verschlechtert?“

Kommentar zu „Intravenöse Vitamin C-Gabe: 28-Tage-Ergebnis septischer Patienten verschlechtert?“

What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023: A narrative review

An update of the effects of vitamins D and C in critical illness

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