A Systematic Review and Meta-Analysis on Possible Role of Vitamin C in Sepsis

Brown, J.; Robertson, Cassie; Sevilla, Luis; Garza, Jorge; Rashid, Hytham; Benitez, Ana C; Shipotko, Mikhail; Ali, Zuhair Hussein

doi:10.7759/cureus.32886

Cited by 10 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three of recent systematic reviews showed reduction in overall mortality with vitamin C mono‐ or combination‐therapy, but certainty of evidence was evaluated as very low, 6 low, 2 or moderate 4 . Other studies did not find firm evidence for a difference in mortality 1,3,5 . One weakness of these studies, including the present review, is the large number of outcomes, including mortality, being evaluated at multiple timepoints, which may increase the risk of identifying effects due to chance alone.…”

Section: Discussionmentioning

confidence: 76%

“…4 Other studies did not find firm evidence for a difference in mortality. 1,3,5 One weakness of these studies, including the present review, is the large number of outcomes, including mortality, being evaluated at multiple timepoints, which may increase the risk of identifying effects due to chance alone. Use of mortality outcomes at multiple timepoints is one of the major weaknesses in our review but is inherent to the current body of evidence on this topic.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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][2][3][4][5][6] Despite a proliferation of studies, vitamin C's effect on the outcomes of patients with sepsis has been unclear. Studies have reached contradictory results, with recent high-quality trials not confirming previously described benefits of vitamin C. [7][8][9][10] Moreover, the largest study published to date suggested harm from vitamin C in the composite outcome of death or persistent organ dysfunction.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Blaser

Alhazzani

Belley‐Côté

et al. 2023

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Blaser

Alhazzani

Belley‐Côté

et al. 2023

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…Many of the studies are small, several studies are observational and the clinical significance of the findings is often uncertain. Some examples are given below 8 14–28…”

Section: Can Parenteral Vitamins Treat or Prevent Disease?mentioning

confidence: 99%

Intravenous vitamin injections: where is the evidence?

2023

DTB

View full text Add to dashboard Cite

The body needs small daily quantities of vitamins and minerals, which are usually obtained from the diet. Intravenous vitamins are used for a few serious medical conditions (eg, malabsorption syndromes with severe vitamin depletion, Wernicke’s encephalopathy or critical illness). Intravenous drips containing high doses of various vitamins and minerals (eg, the so-called ‘Myers’ cocktail’) have been promoted in popular culture to ‘reduce stress’, ‘increase energy’ or ‘boost immunity’, with claims that the intravenous route allows faster absorption of vitamins into the bloodstream than if they are taken orally. There is a lack of high-quality evidence to suggest that high-dose vitamin infusions are necessary or offer any health benefit in the absence of a specific vitamin deficiency or medical condition. There may be harms from taking high (non-physiological) quantities of some vitamins and minerals. Licensed forms of injectable vitamins that are prescription-only medicines should not be advertised to the public and should only be supplied and administered by appropriately qualified healthcare professionals.

show abstract