Mortality in septic patients treated with vitamin C: a systematic meta-analysis.

Published on Jan 6, 2021in Critical Care9.097
· DOI :10.1186/S13054-020-03438-9
Sean S. Scholz1
Estimated H-index: 1
(FUI: Foundation University, Islamabad),
Rainer Borgstedt1
Estimated H-index: 1
(FUI: Foundation University, Islamabad)
+ 3 AuthorsS. Rehberg5
Estimated H-index: 5
(FUI: Foundation University, Islamabad)
Sources
Abstract
BACKGROUND Supplementation of vitamin C in septic patients remains controversial despite eight large clinical trials published only in 2020. We aimed to evaluate the evidence on potential effects of vitamin C treatment on mortality in adult septic patients. METHODS Data search included PubMed, Web of Science, and the Cochrane Library. A meta-analysis of eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only studies with valid classifications of sepsis and intravenous vitamin C treatment (alone or combined with hydrocortisone/thiamine) were included. RESULTS A total of 17 studies including 3133 patients fulfilled the predefined criteria and were analyzed. Pooled analysis indicated no mortality reduction in patients treated with vitamin C when compared to reference (risk difference - 0.05 [95% CI - 0.11 to - 0.01]; p = 0.08; p for Cochran Q = 0.002; I2 = 56%). Notably, subgroup analyses revealed an improved survival, if vitamin C treatment was applied for 3-4 days (risk difference, - 0.10 [95% CI - 0.19 to - 0.02]; p = 0.02) when compared to patients treated for 1-2 or > 5 days. Also, timing of the pooled mortality assessment indicated a reduction concerning short-term mortality (< 30 days; risk difference, - 0.08 [95% CI - 0.15 to - 0.01]; p = 0.02; p for Cochran Q = 0.02; I2 = 63%). Presence of statistical heterogeneity was noted with no sign of significant publication bias. CONCLUSION Although vitamin C administration did not reduce pooled mortality, patients may profit if vitamin C is administered over 3 to 4 days. Consequently, further research is needed to identify patient subgroups that might benefit from intravenous supplementation of vitamin C.
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Introduction:We aimed to study the use of ascorbic acid, thiamine, and steroids (ATS) in patients with septic shock (SS).Methods:Data on 62 patients with SS were collected from Acute Physiologic an...
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#2Robert A. Fowler (Sunnybrook Health Sciences Centre)H-Index: 76
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#2David T. Huang (University of Pittsburgh)H-Index: 31
Importance The combination of ascorbic acid, corticosteroids, and thiamine has been identified as a potential therapy for septic shock. Objective To determine whether the combination of ascorbic acid, corticosteroids, and thiamine attenuates organ injury in patients with septic shock. Design, Setting, and Participants Randomized, blinded, multicenter clinical trial of ascorbic acid, corticosteroids, and thiamine vs placebo for adult patients with septic shock. Two hundred five patients were enro...
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#15Tae Gun Shin (SKKU: Sungkyunkwan University)H-Index: 3
#16Won Young Kim (UOU: University of Ulsan)H-Index: 28
To evaluate the effects of early combination therapy with intravenous vitamin C and thiamine on recovery from organ failure in patients with septic shock. The ascorbic acid and thiamine effect in septic shock (ATESS) trial was a multi-centre, double-blind, randomized, controlled trial conducted in four academic emergency departments, enrolling adult patients with septic shock from December 2018 through January 2020. Patients were randomly assigned in a 1:1 ratio to either the treatment group [in...
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#1Jose Iglesias (Seton Hall University)H-Index: 8
#2Andrew Vassallo (Community Medical Center)H-Index: 2
Last. Yasmine Elbaga (Monmouth Medical Center)H-Index: 2
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Abstract Background Sepsis is a major public health burden resulting in 25-30% in-hospital mortality and accounting for over 20 billion dollars of United States hospital costs. Methods This was a randomized, double-blinded, placebo controlled trial conducted from February 2018 to June 2019 assessing an ascorbic acid (AA), thiamine, and hydrocortisone (HAT) treatment bundle for the management of septic and septic shock patients admitted to an intensive care unit (ICU). The primary outcomes were r...
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#1Ping Chang (Southern Medical University)H-Index: 7
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Background Whether hydrocortisone, vitamin C, and thiamine treatment can reduce the mortality of patients with sepsis is controversial. Research Question To evaluate the efficacy and safety of hydrocortisone, vitamin C, and thiamine combination treatment for patients with sepsis or septic shock. Study Design and Methods This single-blind, randomized controlled trial evaluated treatment with hydrocortisone (50 mg every 6 h for 7 days), vitamin C (1.5 g every 6 h for 4 days), and thiamine (200 mg ...
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While the use of vitamin C as a therapeutic agent has been investigated since the 1950s, there has been substantial recent interest in the role of vitamin C supplementation in critical illness and particularly, sepsis and septic shock. Humans cannot synthesize vitamin C and rely on exogenous intake to maintain a plasma concentration of approximately 70 to 80 μmol/L. Vitamin C, in healthy humans, is involved with antioxidant function, wound healing, endothelial function, and catecholamine synthes...
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The dysregulated host response and organ damage following systemic infection that characterizes a septic event predisposes individuals to a chronic immunoparalysis state associated with severe transient lymphopenia and diminished lymphocyte function, thereby reducing long-term patient survival and quality of life. Recently, we observed lasting production of reactive oxygen species (ROS) in mice that survive sepsis. ROS production is a potent mechanism for targeting infection, but excessive ROS p...
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