The clinical benefits of perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery: a meta-analysis

Abstract

The clinical benefits of perioperative antioxidant vitamin therapy in cardiac patients remain controversial. Here, we conducted a meta-analysis to determine the strength of the evidence supporting the perioperative use of antioxidant vitamins in patients undergoing cardiac surgery. We searched 4 databases (PubMed, EMBASE, Science Citation Index and Cochrane Library) for randomized controlled trials that reported the effects of antioxidant vitamin therapy on patients undergoing cardiac surgery until 6 June 2016. Risk ratio (RR) or mean difference (MD) and its 95% confidence interval (95% CI) served as the summarized results. Heterogeneity among included studies was evaluated using the I2 statistic, which help determine which effect model to apply. We constructed a funnel plot to assess the existence of publication bias. Sensitivity analyses were also conducted to evaluate the robustness of the outcomes. Twelve trials with 1584 cardiac patients were included. Compared with placebo or no antioxidant vitamin therapy, administration of antioxidant vitamin therapy resulted in a reduction in postoperative atrial fibrillation (POAF) (RR 0.55, 95% CI 0.42, 0.73, P < 0.0001), duration of hospital stay (MD -0.68, 95% CI -0.98, -0.39, P < 0.00001), intensive care unit length of stay (MD -0.21, 95% CI -0.30, -0.12, P < 0.00001) and intubation time (MD -2.41, 95% CI -3.83, -0.98, P = 0.001). Our results also showed a trend towards a decrease in postoperative complications (RR 0.72, 95% CI 0.48, 1.08, P = 0.11) and duration of POAF (MD -1.950, 95% CI -3.28, 0.29, P = 0.10). This meta-analysis demonstrated that perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery can reduce the incidence of POAF, duration of hospital stay, intensive care unit length of stay and intubation time.

Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

“…A reduced ICU-LOS was also observed by three meta-analyses focusing exclusively on perioperative vitamin C administration [11,13,15] and one meta-analysis investigating the antioxidant effects of vitamins by Geng et al [38]. Four meta-analyses also found significantly shorter hospital-LOS associated with vitamin C [11,15,39,40].…”

Vitamin C to Improve Organ Dysfunction in Cardiac Surgery Patients&mdash;Review and Pragmatic Approach

“…Considering the above-mentioned evidence and the data gained from meta-analyses and RCTs, as listed in Table 2 and • Vitamin C might also reduce intubation time and postoperative complications as found by the meta-analyses of Hu and Shi [25,60].…”

“…Reduced intubation time after cardiac surgery was shown in a meta-analysis including 3 RCTs and 575 patients (mean difference: -2.41, 95% confidence interval -3.82/-0.98, p= 0.001). However, the heterogeneity of the included trials was high (p= 0.74)[25]. reduced glomerular filtration rates and impaired creatinine clearance as shown in (Figure 5).…”

Vitamin C to Improve Organ Dysfunction in Cardiac Surgery Patients—Review and Pragmatic Approach

“…Vitamin C treatment also improves ventricular function, reduces vasopressor and fluid demand [ 86 , 87 ] and increases the cardiac index. In a systematic review [ 88 ] and in 6 different meta-analyses including 8–15 RCTs [ 59 , 60 , 63 , 89 , 90 , 91 ], vitamin C was shown to significantly reduce the occurrence of postoperative cardiac arrhythmia, mainly atrial fibrillation (AF). However, the results of these meta-analyses might be strongly influenced by publication bias, as discussed by Hemilae [ 92 ].…”

“…Reduced intubation time after cardiac surgery was shown in a meta-analysis including 3 RCTs and 575 patients (mean difference: −2.41, 95% confidence interval −3.82/−0.98, p = 0.001). However, the heterogeneity of the included trials was high ( p = 0.74) [ 63 ].…”