Vitamin C Treatment May Be Beneficial for Sepsis, But Duration and Dose Unclear

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — There is low-quality strong evidence that vitamin C treatment is associated with significantly lower mortality rates, shorter lengths of intensive care unit (ICU) stay, and shorter duration of vasopressor use in patients with sepsis, according to a study presented at the CHEST Annual Meeting 2018 in San Antonio, Texas.

In ICUs, severe sepsis and septic shock remain leading causes of death. Vitamin C’s antioxidant properties are known to improve microvascular integrity and prevent endothelial damage. It is also a cofactor in the synthesis of catecholamines. In addition, vitamin C is of a bactericidal and bacteriostatic nature, both of which contribute to its beneficial effects in patients with septic shock.

Given these known properties and effects, researchers conducted a meta-analysis to gather more supporting data regarding the use of vitamin C in patients with sepsis.

The meta-analysis was based on 3 studies, 2 of which were randomized and 1 of which was retrospective, totaling 138 patients, 69 of whom received vitamin C. These studies were found by conducting a systematic search of the Cochrane Library, PubMed, and Scopus for relevant articles published up to January 2018. The researchers then used either random or fixed effects models based on heterogeneity and the Mental-Haenszel method for analysis. Heterogeneity <30% was considered low, ≥30% to 60% was considered moderate, and >60% was considered substantial. A random model was used for heterogeneity >60%.

Mortality rates were significantly lower in the patients in the vitamin C group (13% vs 47.8%; odds ratio 0.15; 95% CI, 0.06-0.36; P <.001; I2=0%). Vitamin C was also associated with significantly lower ICU stay lengths — a mean difference of 1.49 days fewer (95% CI, -1.94 to -1.04; P <.00001; I2=0%) — and a mean difference of 30.22 fewer hours of vasopressor use (95% CI, -44.47 to -15.98; P <.0001; I2=69%).

The researchers affirmed that the study results were encouraging, however, there was no clear evidence regarding optimal duration of vitamin C treatment or the recommended dosage. The study also significantly lacked scope, in that it examined only 138 patients in 3 studies, suggesting there is need for a much larger study of higher quality evidence.

Ultimately, the researchers “do not recommend routine use of vitamin C in patients with severe sepsis and septic shock.”

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Reference

Velagapudi RK, Upadhaya S, Aburahma A, Bachuwa G. Use of vitamin C in patients with sepsis is associated with lower mortality: a meta-analysis. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.