Vitamin C-based regimens for sepsis and septic shock: Systematic review and meta-analysis of randomized clinical trials.

Martimbianco, Ana Luiza Cabrera; Pacheco, Rafael Leite; Bagattini, Ângela Maria; Moreira, Roberta de Fátima Carreira; Azevedo, Luciano César Pontes; Riera, Rachel

doi:10.1016/j.jcrc.2022.154099

Cited by 15 publications

(11 citation statements)

References 42 publications

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“…Vitamin C, as an antioxidant, has been widely used in many diseases sharing the same pathophysiologic characteristics as sepsis, ARDS, etc. 36 , 37 It has been well proven that vitamin C can effectively attenuate oxidative stress, for which it may slow down the remodeling of lung structure and furtherly the deterioration of lung function. 38 For instance, increased oxidative stress can lead to dysregulated antiproteases in lung tissue, which is the core of the pathogenesis of emphysema in COPD.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Vitamin C Supplementation on Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Lei¹,

Lu²,

Yu³

et al. 2022

COPD

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Background In recent years, the pleiotropic roles of antioxidants have drawn extensive attention in various diseases. Vitamin C is a well-known antioxidant, and it has been used to treat patients with chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis aim to demonstrate the impact of vitamin C supplementation in patients with COPD. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), SinoMed, Wanfang, and China Science and Technology Journal Database (cqvip.com) for eligible randomized controlled trials (RCTs) from their respective inception to May 18 th , 2021, by using the searching terms of COPD, vitamin C, and RCTs. A meta-analysis was performed to evaluate the effects of vitamin C on lung function, antioxidant levels, and nutritional conditions in COPD patients by using Review Manager (Version 5.4). Results Ten RCTs including 487 participants were eligible for our study. Meta-analysis results showed that vitamin C supplementation (≥400 mg/day) can significantly improve the forced expiratory volume in one second as a percentage (FEV1%) in COPD (SMD:1.08, 95% CI:0.03, 2.12, P =0.04). Moreover, vitamin C supplementation significantly improved the ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) (WMD:0.66, 95% CI: 0.26, 1.06, P =0.001), vitamin C level in serum (SMD:0.63, 95% CI: 0.02, 1.24, P =0.04) and glutathione (GSH) level in serum (SMD:2.47, 95% CI: 1.06, 3.89, P =0.0006). While no statistically significant difference was observed in body mass index (BMI), fat-free mass index (FFMI), vitamin E level and superoxide dismutase (SOD) level in serum. Conclusion Vitamin C supplementation could increase the levels of antioxidation in serum (vitamin C and GSH) and improve lung function (FEV1% and FEV1/FVC), especially in patients treated with vitamin C supplementation greater than 400 mg/day. However, further prospective studies are needed to explore the role of vitamin C in improving nutritional status.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Vitamin C Supplementation on Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Lei¹,

Lu²,

Yu³

et al. 2022

COPD

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“…The Surviving Sepsis Campaign of 2021: International Guidelines for Management of Sepsis and Septic Shock suggest IVVC for patients with sepsis or septic shock was not recommended, only as a weak recommendation according to the low quality of evidence [12]. Although systematic reviews and meta-analyses discussing IVVC in patients with sepsis were recently published [11,13,14], these studies did not include the newer randomized controlled trials (RCTs) [15][16][17] with a larger population of patients to provide better evidence.…”

Section: Introductionmentioning

confidence: 99%

The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials

Liang

Su²,

Shao

et al. 2023

Crit Care

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Background To update a meta-analysis of randomized controlled trials (RCTs) and further explore the outcome of IV vitamin C (IVVC) administration in sepsis or septic shock patients. Methods This study is a meta-analysis of RCTs. The RCTs of vitamin C therapy in sepsis or septic shock were searched in PubMed, EMBASE and Clinical Trials.gov from inception to January 16, 2023. We registered the protocol with PROSPERO (CRD42022354875). The primary outcome was delta Sequential Organ Failure Assessment (SOFA) score at 72–96 h. Two reviewers independently assessed RCTs according to eligibility criteria: (1) study type: RCT; (2) patient population: patients ≥ 18 years with sepsis or septic shock; (3) intervention: IVVC at any doses as monotherapy or combined with thiamine or and hydrocortisone compared with standard of care, no intervention or placebo (defined as control group); (4) the RCT described short-term mortality or SOFA score. Then, two authors independently extracted related information from RCTs. Results Eighteen RCTs (n = 3364 patients) were identified in this meta-analysis. There were significant effects in the delta SOFA score from baseline to 72–96 h (MD, − 0.62; 95% CI, − 1.00 to − 0.25; p = 0.001) and the duration of vasopressor use (MD, − 15.07; 95% CI, − 21.59 to − 8.55; p < 0.00001) with IVVC therapy. Treatment with IVVC was not shown to improve short-term mortality (OR, 0.89; 95% CI, 0.77 to 1.04; p = 0.14); nevertheless, dose at 25–100 mg/kg/d subgroup associated with a significant reduction in short-term mortality (OR, 0.80; 95% CI, 0.65 to 0.97; p = 0.03). An increase adverse event was observed in IVVC therapy (OR, 1.98; 95% CI, 1.06 to 3.68; p = 0.03). Conclusion In this meta-analysis, IVVC in sepsis or septic shock patients significantly improved delta SOFA score and reduced the duration of vasopressor use, whereas it was not associated with reduction in short-term mortality and had higher adverse events.

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“…Given its antioxidant properties, researchers hypothesize that vitamin C may attenuate the systemic response to infection that results in organ failure and poor patient outcomes in sepsis. Few interventions in the critically ill population have gained as much attention as vitamin C, with at least six systematic reviews published during the last year alone 1–6 …”

Section: Introductionmentioning

confidence: 99%

Intravenous vitamin C therapy in adult patients with sepsis: A rapid practice guideline

Blaser

Alhazzani

Belley‐Côté

et al. 2023

Acta Anaesthesiol Scand

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BackgroundThis Rapid Practice Guideline provides an evidence‐based recommendation to address the question: in adults with sepsis or septic shock, should we recommend using or not using intravenous vitamin C therapy?MethodsThe panel included 21 experts from 16 countries and used a strict policy for potential financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. Based on an updated systematic review, and the grading of recommendations, assessment, development, and evaluation approach, we evaluated the certainty of evidence and developed recommendations using the evidence‐to‐decision framework. We conducted an electronic vote, requiring >80% agreement among the panel for a recommendation to be adopted.ResultsAt longest follow‐up, 90 days, intravenous vitamin C probably does not substantially impact (relative risk 1.05, 95% confidence interval [CI] 0.94 to 1.17; absolute risk difference 1.8%, 95% CI −2.2 to 6.2; 6 trials, n = 2148, moderate certainty). Effects of vitamin C on mortality at earlier timepoints was of low or very low certainty due to risk of bias of the included studies and significant heterogeneity between study results. Few adverse events were reported with the use of vitamin C. The panel did not identify any major differences in other outcomes, including duration of mechanical ventilation, ventilator free days, hospital or intensive care unit length of stay, acute kidney injury, need for renal replacement therapy. Vitamin C may result in a slight reduction in duration of vasopressor support (MD −18.9 h, 95% CI −26.5 to −11.4; 21 trials, n = 2661, low certainty); but may not reduce sequential organ failure assessment scores (MD −0.69, 95% CI −1.55 to 0.71; 24 trials, n = 4002, low certainty). The panel judged the undesirable consequences of using IV vitamin C to probably outweigh the desirable consequences, and therefore issued a conditional recommendation against using IV vitamin C therapy in sepsis.ConclusionsThe panel suggests against use of intravenous vitamin C in adult patients with sepsis, beyond that of standard nutritional supplementation. Small and single center trials on this topic should be discouraged.

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Vitamin C-based regimens for sepsis and septic shock: Systematic review and meta-analysis of randomized clinical trials.

Cited by 15 publications

References 42 publications

Efficacy of Vitamin C Supplementation on Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Efficacy of Vitamin C Supplementation on Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials

Intravenous vitamin C therapy in adult patients with sepsis: A rapid practice guideline

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