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Intravenous Vitamin C for Sepsis

6/18/2019 2:05:33 PM
vitamin cSepsis is associated with organ failure and a high mortality rate in intensive care units (ICUs). Depletion of vitamin C is common in patients with sepsis because of the scavenging of free radicals, and its depletion correlates inversely with survival. Intravenous (IV) vitamin C has recently been explored in clinical trials as a therapeutic option for critically ill patients with sepsis.

Intravenous vitamin C studied for potential benefit in sepsis cases

To quantify the effects of IV vitamin C in patients with sepsis, a meta-analysis was performed and published in Critical Care in 2018. Three studies, published between 2014 and 2017, were included in the analysis. Two were randomized, double-blind, placebo-controlled clinical trials, and one was a before-and-after study.
In total, the 3 studies included 146 adult patients with severe sepsis or septic shock. The protocol for vitamin C administration was 1.5 g IV every 6 hours in one study, 25 mg/kg IV every 6 hours in another, and 50 mg/kg/day or 200 mg/kg/day in the last. Meta-analyses were performed for 3 outcome measures: mortality, ICU length of stay, and duration of vasopressor use. 

Studies show intravenous vitamin C significantly reduces mortality

Pooled analysis revealed a significant reduction in mortality with the use of vitamin C (odds ratio [OR] = 0.17; 95% CI, 0.07-0.40; p<0.001). The effect size was so strong that 9 studies with null findings would be needed to render this pooled result nonsignificant. Pooled analysis favored the use of vitamin C for ICU length of stay, but the result was not statistically significant (standardized mean difference [SMD] = -0.30; 95% CI, -0.83 to 0.23). Finally, pooled analysis showed a significant reduction in duration of vasopressor use in the vitamin C group (SMD = -1.57 hours; 95% CI, -2.03 to -1.11; p<0.001).
Heterogeneity was found to be nonsignificant for all of the outcomes assessed, indicating that the results were consistent among studies. The findings that IV vitamin C reduced the odds of mortality by 83% and shortened the duration of vasopressor use by more than 90 minutes are encouraging. If confirmed by additional studies, IV vitamin C may have the potential to dramatically improve outcomes patients with severe sepsis or septic shock.
Li J. Evidence is stronger than you think: a meta-analysis of vitamin C use in patients with sepsis. Crit Care. 2018; 22: 258.
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