Use of Intravenous Vitamin C in Critically Ill Patients With COVID-19 Infection

Abstract

Introduction The pathophysiology for Coronavirus Disease 2019 (COVID-19) infection is characterized by cytokine oxidative stress and endothelial dysfunction. Intravenous (IV) vitamin C has been utilized as adjuvant therapy in critically ill patients with sepsis for its protective effects against reactive oxygen species and immunomodulatory effects. The primary objective of this study was to evaluate the effects of IV vitamin C in critically ill patients with COVID-19 infection. Methods Retrospective observational cohort study with propensity score matching of intensive care unit (ICU) patients who received 1.5 grams IV vitamin C every 6 hours for up to 4 days for COVID-19 infection. The primary study outcome was in-hospital mortality. Secondary outcomes included vasopressor requirements in norepinephrine equivalents, ICU length of stay, and change in Sequential Organ Failure Assessment (SOFA) score. Results Eight patients received IV vitamin C and were matched to 24 patients. Patients in the IV vitamin C group had higher rates of hospital mortality [7 (88%) vs. 19 (79%), P = 0.049]. There was no difference in the daily vasopressor requirement in the treatment group or between the 2 groups. The mean SOFA scores post-treatment was higher in the IV vitamin C group (12.4 ± 2.8 vs. 8.1 ± 3.5, P < 0.005). There was no difference in ICU length of stay between the treatment and control groups. Conclusion Adjunctive IV vitamin C for the management of COVID-19 infection in critically ill patients may not decrease the incidence of mortality, vasopressor requirements, SOFA scores, or ventilator settings.

Clinical significance of micronutrient supplements in patients with coronavirus disease 2019: A comprehensive systematic review and meta-analysis

“…The duration of treatment varied from four to 18 days. There was a low risk of bias for seven studies [8,11,14,21,22,24,25], while the risk of bias for two studies was high [13,20], as shown in Supplementary Table 2.…”

“…The mean age was 61.0 ± 15.02, and 57.4% were males. These studies were conducted in China [8,14,22], Iran [13], Pakistan [20], Saudi Arabia [24], Turkey [25], and United States [11,21]. The studies provided daily doses alone [11,13,14,20e22,24,25] or daily doses after a loading dose [8].…”

“…The studies provided IV [8,13,14,20e22,25] or oral [11,24] vitamin C supplementations. Daily doses used were oral 1 gm [24] and 8 gm [11] daily, and IV 50 mg/kg/day [20], 2 gm [25], 2e4 gm [22], 6 gm [8,13,21], or 24 gm [14] daily. The loading dose was 6 gm IV infusion for 12 h [8].…”

Nutritional risk of vitamin D, vitamin C, zinc, and selenium deficiency on risk and clinical outcomes of COVID-19: A narrative review

“…Other observational studies with hospitalized COVID-19 patients who received high-dose intravenous vitamin C (HDIVC) also reported improvements in oxygen support status, reduced mortality [27], and improvements in the inflammatory response [28,29], and immune and coagulation function [28]. Different results were found by , in which intravenous vitamin C did not decrease the incidence of mortality, vasopressor requirements, sequential organ failure assessment score (SOFA score) or ventilator settings [30].…”

The Role of Complementary and Alternative Medicines in the Treatment and Management of COVID-19

“…Moreover, some studies show that adjunctive intravenous administration of vitamin C for the treatment of infection in critically ill COVID-19 patients was unable to reduce the rate of mortality, ventilator settings, the requirement of vasopressor, etc. [84]. Therefore although vitamin C is vital for lessening the inflammatory response and assists in boosting the immune system of the host, there is a lack of substance to support that utilization of vitamin C at a high dose can be successful in the prevention or management of COVID-19.…”