An observational study on the relationship between plasma vitamin C, blood glucose, oxidative stress, endothelial dysfunction and outcome in patients with septic shock

Katundu, Kondwani; Hill, Lee; Davids, Lester M.; Joubert, Ivan; Miller, Malcolm; Piercy, J; Michelle, William L

doi:10.7196/sajcc.2016.v32i1.270

Cited by 5 publications

(5 citation statements)

References 43 publications

(50 reference statements)

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“…A particular vitamin C level may simply be a marker for the various pathological processes rather than being implicated in the actual processes themselves. If this was the case, there would be no benefit from administration of vitamin C. Nevertheless, low levels of vitamin C in hospital patients still occur [82,83,84,85,86,87,88,89], and there is modern evidence that vitamin C metabolism is changed under various forms of severe physiological stress such as surgery, sepsis, and trauma [90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105]. Hence, the question of the clinical importance of low vitamin C levels in hospital patients is as relevant today as it was in the 1930s.…”

Section: Discussionmentioning

confidence: 99%

“…There are a variety of biochemical reactions in which vitamin C plays a part, a large number of physiological processes that are consequently influenced, and a large number of clinical effects of vitamin C that have been observed in controlled trials [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49]. Given this, and the evidence for low vitamin C levels and increased metabolism of vitamin C in critically ill patients [90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105], it seemed reasonable to examine whether vitamin C influences practical outcomes, such as the length of ICU stay and the duration of mechanical ventilation without any restrictions on specific medical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there is evidence that vitamin C metabolism is changed in many conditions that involve physiological stress, such as infections, surgery, traumas, and burns, in which case vitamin C levels can decline dramatically [90,91,92,93,94,95,96,97,98,99,100,101]. Although 0.1 g/day of vitamin C can maintain a normal plasma level in a healthy person [62], much higher doses (1–4 g/day) are needed for critically ill patients to increase plasma vitamin C levels to the normal range [102,103,104,105].…”

Section: Introductionmentioning

confidence: 99%

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Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

2019

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A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1–3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

2019

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“…10,50,51 One of the most used assays to access the oxidative stress is the measurement of thiobarbituric acid reactive substances (TBARS), produced as a subproduct of lipidic peroxidation, resulting from tissue injuries generated by oxidative stress. [52][53][54] It was observed a significant increase in TBARS in serum and liver tissue samples in septic animals in comparison with the other groups, which was reverted by ω3 (Figure 4A,B). Another biomarker used to evaluate ROS in our study was 2,7-dihydrodichlorofluorescein diacetate (DCF).…”

Section: Discussionmentioning

confidence: 99%

Fish Oil - Omega-3 Exerts Protective Effect in Oxidative Stress and Liver Dysfunctions Resulting from Experimental Sepsis

Velasque

Branchini

Catarina

et al. 2023

Journal of Clinical and Experimental Hepatology

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“…A combination of mediators released from endothelial cells and biomarkers of glycocalyx breakdown was reported in 43% [13/30] of studies (17-24, 32, 35, 37, 40, 41). The number of studies reporting only endothelial cell mediators in plasma was 27% (8/30) (26, 27,31,33,38,39,45,46), while those that exclusively reported biomarkers of glycocalyx shedding were 13% (4/30) (28, 34, 36, 44) (Supplementary Table 2).…”

Section: Endotheliopathy Assessmentmentioning

confidence: 99%

A systematic review and meta-analysis on endothelial dysfunction post-shock resuscitation

Obonyo,

Sela,

Raman

et al. 2023

Preprint

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Introduction Shock-induced endotheliopathy (SHINE), defined as a profound sympathoadrenal hyperactivation in shock states leading to endothelial activation, glycocalyx damage, and eventual compromise of end-organ perfusion, was first described in 2017. The aggressive resuscitation therapies utilised in treating shock states could potentially lead to further worsening endothelial activation and end-organ dysfunction. Objective This study aimed to systematically review the literature on resuscitation-associated and resuscitation-induced endothelial dysfunction. Methods A pre-determined structured search of literature published over an eleven-year period (1 January 2011 to 31 December 2022) was performed in two indexed databases (PubMed/MEDLINE and EMBASE) per PRISMA guidelines. Results Thirty studies met the inclusion criteria and were included in the final qualitative synthesis. Most of these studies (43%) reported on a combination of mediators released from endothelial cells and biomarkers of glycocalyx breakdown, while only 20% reported on microvascular flow changes. Only eight individual studies were included in the quantitative meta-analysis based on the comparability of the parameters assessed. Six studies measured syndecan-1, with a heterogeneity index, I2 = 75.87% (pooled effect-size; z = 2.00; mean = 0.43; 95% CI 0.01 to 0.85; p = 0.05). Thrombomodulin was measured in 4 comparable studies (I2 = 78.93%; z = 1.57; mean = 0.41; 95% CI -0.10 to 0.92; p = 0.12). Conclusion Acute resuscitation therapies administered could exacerbate endothelial dysfunction in shock states. In the included studies, syndecan-1 had the highest frequency of assessment in the post-resuscitation period and changes in concentrations showed a statistically significant effect of the resuscitation. There are inadequate data available in this area and further research and standardisation of the ideal assessment and panel of biomarkers are urgently needed.

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An observational study on the relationship between plasma vitamin C, blood glucose, oxidative stress, endothelial dysfunction and outcome in patients with septic shock

Cited by 5 publications

References 43 publications

Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

Fish Oil - Omega-3 Exerts Protective Effect in Oxidative Stress and Liver Dysfunctions Resulting from Experimental Sepsis

A systematic review and meta-analysis on endothelial dysfunction post-shock resuscitation

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