Perioperative Vitamin C and E levels in Cardiac Surgery Patients and Their Clinical Significance

Abstract

Background: Oxidative stress contributes to organ dysfunction after cardiac surgery and still represents a major problem. Antioxidants, such as vitamins C and E might be organ protective. Methods: The primary objective of this prospective observational study was the description to evaluate the perioperative vitamin C and E levels in 56 patients undergoing cardiac surgery with the use of cardiopulmonary bypass. The association of vitamin C with inflammatory reaction, oxidative stress, organ dysfunctions, and clinical outcomes were evaluated in an explorative approach. Results: Vitamin C levels decreased significantly from 6.5 (3.5–11.5) mg/L before surgery to 2.8 (2.0–3.9) mg/L 48 h after surgery (p < 0.0001). Fifty-six percent of patients had a suboptimal vitamin C status even before surgery. In protein-denaturized probes, significantly higher vitamin C concentrations were detected (p = 0.0008). Vitamin E levels decreased significantly from preoperative level 11.6 (9.5–13.2) mg/L to 7.1 (5.5–7.4) mg/L, (p = 0.0002) at the end of cardiopulmonary bypass, remained low during the first day on ICU and recovered to 8.2 (7.1–9.3) mg/L 48 h after surgery. No patient was vitamin E deficient before surgery. Analysis showed no statistically significant association of vitamin C with inflammation, oxidative stress or organ dysfunction levels in patients with previously suboptimal vitamin C status or patients with a perioperative decrease of ≥50% vitamin C after surgery. Patients with higher vitamin C levels had a shorter ICU stay than those who were vitamin C depleted, which was not statistically significant (72 versus 135 h, p = 0.1990). Conclusion: Vitamin C and E levels significantly declined intraoperatively and remained significantly reduced low for 2 days after cardiac surgery. The influence of reduced serum levels on the inflammatory reaction and clinical outcome of the patients remain unclear in this small observational study and need to be investigated further. Given vitamin C´s pleiotropic role in the human defense mechanisms, further trials are encouraged to evaluate the clinical significance of Vitamin C in cardiac surgery patients.

Effect of Ascorbic Acid on Cardiac Surgery-Associated Acute Kidney Injury Incidence

“…The results are also in accordance with the study of Hill et al, who reported no significant differences regarding postoperative inflammatory response as assessed by mean postoperative WBC levels (p ¼ 0.677). 21 In 2012, Jouybar et al 22 performed a similar, but smaller study investigating the effect of perioperative supplementation of AA in 40 elective on-pump CABG patients. No significant difference between the study groups regarding the postoperative inflammatory response as well as kidney function was identified.…”

“…The results are also in accordance with the study of Hill et al, who reported no significant differences regarding postoperative inflammatory response as assessed by mean postoperative WBC levels ( p = 0.677). 21 …”

The effects of surgery on plasma/serum vitamin C concentrations: a systematic review and meta-analysis

“…Additionally, surgical information such as the length of surgery, type of anaesthetic and surgical complications were only reported in 4 trials. (60,62,71,72) Various studies did take into account a range of additional vital biomarkers including vitamin E concentrations, haematocrit concentrations indicative of hemodilution, (66) biomarkers of oxidative stress (44,45) and the type of anaesthetic administered. (60) Gender differences were only considered in one trial, (47) which were averaged for the purpose of our analysis.…”

“…Only studies presenting with a low to unclear risk of bias were included into the meta-analysis (Figure 2), with those reporting a high risk of bias on at least one of the assessment domains being excluded from the meta-analysis (Figure 3). Mean pre-operative vitamin C concentrations varied between studies, with only three studies (49,59,71) reporting mean plasma vitamin C concentrations indicative of a inadequate/deficient concentration (< 28 µmol/L). (75) Twenty-one studies assessed plasma vitamin C concentrations within 7 days post-operatively.…”

Vitamin C – neue Therapiemöglichkeit bei Sepsis?

“…Die normale Plasmakonzentration von Vitamin C liegt bei 50-80 μmol/l (0,9-1,44 mg/dl). Bei Werten < 50 μmol/l liegt ein suboptimaler Vitamin-C-Status vor [21]. Eine Hypovitaminose wird definiert über eine Konzentration < 23 μmol/l.…”