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Among patients with sepsis and acute respiratory distress syndrome (ARDS), administration of high-dose vitamin C via intravenous (IV) infusion does not significantly reduce organ failure, according to double-blind multicenter clinical trial (CITRIS-ALI; ClinicalTrial.gov Identifier: NCT02106975) results published in the Journal of the American Medical Association.1
ARDS is a common sepsis-associated organ injury and results in significant mortality.1 Previous research has found that vitamin C attenuates systemic inflammation, corrects sepsis-induced coagulopathy, and attenuates vascular injury.2-4 Therefore, researchers sought to determine the effects of IV vitamin C infusion on organ failure scores and biologic markers of inflammation and vascular injury in 167 patients with sepsis and ARDS.1
Patients were randomly assigned to receive IV vitamin C (50 mg/kg in dextrose 5% in water; n=84) or placebo (dextrose 5% in water only; n=83) every 6 hours for 96 hours. Of the 103 patients who completed the study, the researchers found that there were no significant differences between patients who received the vitamin C infusion and patients who received placebo in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours or in C-reactive protein levels and thrombomodulin levels at 168 hours.
The investigators concluded that, “In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury.”1 However, further research is warranted to evaluate the potential role of vitamin C in other outcomes in sepsis and ARDS.
References
1. Fowler AA III, Truwit JD, Hite RD, et al. Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure. The CITRIS-ALI randomized clinical trial. JAMA. 2019;322(13):1261-1270.
2. Fisher BJ, Kraskauskas D, Martin EJ, et al. Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid. Am J Physiol Lung Cell Mol Physiol. 2012;303(1):L20-L32.
3. Fisher BJ, Seropian IM, Kraskauskas D, et al. Ascorbic acid attenuates lipopolysaccharide-induced acute lung injury. Crit Care Med. 2011;39(6):1454-1460.
4. Fowler AA III, Syed AA, Knowlson S, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014;12:32.
