Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients

Berger, Mette M.; Soguel, Ludivine; Shenkin, Alan; Revelly, Jean-Pierre; Pinget, Christophe; Baines, Malcolm G.; Chioléro, René

doi:10.1186/cc6981

Cited by 177 publications

(165 citation statements)

References 53 publications

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…This approximates the minimal dose of parenteral ascorbate (1000 mg ascorbate/day) that raises the plasma ascorbate concentration of septic patients into the range of normal plasma levels (35). The dose should be tolerated well, judging from clinical trials that injected 1000-2000 mg ascorbate every 8-24 h for up to 7 days in critically ill surgical or acutely injured patients (5,11,16,39).…”

Section: Vitamin C Dosage and Safetymentioning

confidence: 99%

Evaluation of Vitamin C for Adjuvant Sepsis Therapy

Wilson

2013

Antioxidants & Redox Signaling

View full text Add to dashboard Cite

Significance: Evidence is emerging that parenteral administration of high-dose vitamin C may warrant development as an adjuvant therapy for patients with sepsis. Recent Advances: Sepsis increases risk of death and disability, but its treatment consists only of supportive therapies because no specific therapy is available. The characteristics of severe sepsis include ascorbate (reduced vitamin C) depletion, excessive protein nitration in microvascular endothelial cells, and microvascular dysfunction composed of refractive vasodilation, endothelial barrier dysfunction, and disseminated intravascular coagulation. Parenteral administration of ascorbate prevents or even reverses these pathological changes and thereby decreases hypotension, edema, multiorgan failure, and death in animal models of sepsis. Critical Issues: Dehydroascorbic acid appears to be as effective as ascorbate for protection against microvascular dysfunction, organ failure, and death when injected in sepsis models, but information about pharmacodynamics and safety in human subjects is only available for ascorbate. Although the plasma ascorbate concentration in critically ill and septic patients is normalized by repletion protocols that use high doses of parenteral ascorbate, and such doses are tolerated well by most healthy subjects, whether such large amounts of the vitamin trigger adverse effects in patients is uncertain. Future Directions: Further study of sepsis models may determine if high concentrations of ascorbate in interstitial fluid have pro-oxidant and bacteriostatic actions that also modify disease progression. However, the ascorbate depletion observed in septic patients receiving standard care and the therapeutic mechanisms established in models are sufficient evidence to support clinical trials of parenteral ascorbate as an adjuvant therapy for sepsis.

show abstract

Section: Vitamin C Dosage and Safetymentioning

confidence: 99%

Evaluation of Vitamin C for Adjuvant Sepsis Therapy

Wilson

2013

Antioxidants & Redox Signaling

View full text Add to dashboard Cite

show abstract

“…Supplementation of critically ill patients with antioxidant nutrients, alone or in combination, is often referred to as "immune nutrition"; and has been studied in various, double-blind, randomized, placebo-controlled trials [83][84][85]. Although results from some of these trials were encouraging, the benefit of this therapy has not been clearly established.…”

Section: Antioxidant Nutrients In Neurocritical Carementioning

confidence: 99%

Antioxidant Strategies in Neurocritical Care

Hanafy

Selim

2012

Neurotherapeutics

View full text Add to dashboard Cite

An increase in oxidative stress and overproduction of oxidizing reactive species plays an important role in the pathophysiology of several conditions encountered in the neurocritical care setting including: ischemic and hemorrhagic strokes, traumatic brain injury, acute respiratory distress syndrome, sepsis, and organ failure. The presence of oxidative stress in these conditions is supported by a large body of preclinical and clinical studies, and provides a rationale to support a potential therapeutic role for antioxidants. The purpose of this article is to briefly review the basic mechanisms and molecular biology of oxidative stress, summarize its role in critically ill neurological patients, and review available data regarding the potential role of antioxidant strategies in neurocritical care and future directions.

show abstract

“…However, randomized trials attempting to intervene on early AKI have been largely unsuccessful (6)(7)(8)(9). This may, in part, result from misclassification of AKI under frameworks that do not reflect true GFR reduction.…”

Section: Introductionmentioning

confidence: 99%

“…Factors predisposing to FP AKI diagnoses could include a higher degree of variation in laboratory measurement of SCr, a higher degree of biologic variation in creatinine levels (1)(2)(3)(4)(5)11,12), and a higher number of creatinine assays performed. Like all laboratory tests, SCr measurements are affected by within-and between-sample coefficients of variation (CoVs), which for the widely used modified Jaffe rate reaction (5-9,13), range from 0.6% to as high as 9% depending on the true SCr concentration and assay characteristics (6)(7)(8)(9)14). SCr measurements are also associated with intraindividual biologic variation and can be affected by changes in volume status, medications, and creatinine generation during critical illness (1)(2)(3)(4)10,11,15,16).…”

Section: Introductionmentioning

confidence: 99%

False-Positive Rate of AKI Using Consensus Creatinine–Based Criteria

Lin¹,

Fernández

Shashaty

et al. 2015

Clinical Journal of the American Society of Nephrology

102

View full text Add to dashboard Cite

Background and objectives Use of small changes in serum creatinine to diagnose AKI allows for earlier detection but may increase diagnostic false-positive rates because of inherent laboratory and biologic variabilities of creatinine.Design, setting, participants, & measurements We examined serum creatinine measurement characteristics in a prospective observational clinical reference cohort of 2267 adult patients with AKI by Kidney Disease Improving Global Outcomes creatinine criteria and used these data to create a simulation cohort to model AKI false-positive rates. We simulated up to seven successive blood draws on an equal population of hypothetical patients with unchanging true serum creatinine values. Error terms generated from laboratory and biologic variabilities were added to each simulated patient's true serum creatinine value to obtain the simulated measured serum creatinine for each blood draw. We determined the proportion of patients who would be erroneously diagnosed with AKI by Kidney Disease Improving Global Outcomes creatinine criteria.Results Within the clinical cohort, 75.0% of patients received four serum creatinine draws within at least one 48-hour period during hospitalization. After four simulated creatinine measurements that accounted for laboratory variability calculated from assay characteristics and 4.4% of biologic variability determined from the clinical cohort and publicly available data, the overall false-positive rate for AKI diagnosis was 8.0% (interquartile range =7.9%-8.1%), whereas patients with true serum creatinine $1.5 mg/dl (representing 21% of the clinical cohort) had a false-positive AKI diagnosis rate of 30.5% (interquartile range =30.1%-30.9%) versus 2.0% (interquartile range =1.9%-2.1%) in patients with true serum creatinine values ,1.5 mg/dl (P,0.001).Conclusions Use of small serum creatinine changes to diagnose AKI is limited by high false-positive rates caused by inherent variability of serum creatinine at higher baseline values, potentially misclassifying patients with CKD in AKI studies.

show abstract

Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients

Cited by 177 publications

References 53 publications

Evaluation of Vitamin C for Adjuvant Sepsis Therapy

Evaluation of Vitamin C for Adjuvant Sepsis Therapy

Antioxidant Strategies in Neurocritical Care

False-Positive Rate of AKI Using Consensus Creatinine–Based Criteria

Contact Info

Product

Resources

About