The effect of supplementation with vitamins A, B, C, D, and E on disease severity and inflammatory responses in patients with COVID-19: a randomized clinical trial

Beigmohammadi, Mohammad Taghi; Bitarafan, Sama; Hoseindokht, Azin; Abdollahi, Alireza; Amoozadeh, Laya; Soltani, Danesh

doi:10.1186/s13063-021-05795-4

Cited by 41 publications

(74 citation statements)

References 30 publications

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“…The latter could be addressed by performing a meta-analysis. Baseline severity is presented as Sequential Organ Failure Assessment Score (SOFA) (23,28) as Acute Physiology And Chronic Health Evaluation (APACHE II) (29) or other (25,32). *Data from the entire cohort of patients (not only critically ill) are presented.…”

Section: Discussionmentioning

confidence: 99%

“…However, we attempted to address this limitation by performing a sensitivity analysis of the 5 randomized controlled trials. Lastly, the included studies (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) in the meta-analysis did not consistently report on adverse events potentially related to administration of vitamin C, such as oxalate nephropathy, hypernatremia and glucometer error. Nevertheless, relevant evidence before the pandemic indicated that high-dose vitamin C may be relatively safe (36).…”

Section: Discussionmentioning

confidence: 99%

“…2). In the sensitivity analysis of studies with low risk of bias (23,25,(28)(29)(30)32), mortality was 25.1% in the vitamin C group and 32.2% in the control group (RR 1.13, 95% CI 0.59-2.16; p = 0.72; six studies; 1,344 patients; 410 deaths; Supplementary Figure 1); while, in the sensitivity analysis of randomized controlled trials (25,27,29,31,32), the relevant numbers were 10.5 and 17.2%, respectively (RR 0.66, 95% CI 0.39-1.14; p = 0.14; five studies; 346 patients; 48 deaths; Supplementary Figure 2).…”

Section: Observational Studymentioning

confidence: 99%

“…Table3summarizes characteristics of the included studies. Six of them were retrospective observational studies(23,24,26,28,30) and five were randomized controlled trials(25,27,29,31,32). Supplementary Table1summarizes risk of bias assessment of the included studies.…”

mentioning

confidence: 99%

“…Supplementary Table1summarizes risk of bias assessment of the included studies. Six(23,25,(28)(29)(30)32) of them were considered to have low risk of bias.All 11(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) studies provided data on all-cause mortality. Statistical heterogeneity was important (I 2 = 74%).…”

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confidence: 99%

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Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis

et al. 2022

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BackgroundWhether vitamin C provides any benefit when administered in critically ill patients, including those with coronavirus disease (COVID-19), is controversial. We endeavored to estimate the effect of administration of vitamin C on clinical outcomes of critically ill patients with COVID-19 by performing an observational study and subsequent meta-analysis.MethodsFirstly, we conducted an observational study of critically ill patients with laboratory-confirmed COVID-19 who consecutively underwent invasive mechanical ventilation in an academic intensive care unit (ICU) during the second pandemic wave. We compared all-cause mortality of patients receiving vitamin C (“vitamin C” group) or not (“control” group) on top of standard-of-care. Subsequently, we systematically searched PubMed and CENTRAL for relevant studies, which reported on all-cause mortality (primary outcome) and/or morbidity of critically ill patients with COVID-19 receiving vitamin C or not treatment. Pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO.ResultsIn the observational study, baseline characteristics were comparable between the two groups. Mortality was 20.0% (2/10) in the vitamin C group vs. 47.6% (49/103; p = 0.11) in the control group. Subsequently, the meta-analysis included 11 studies (6 observational; five randomized controlled trials) enrolling 1,807 critically ill patients with COVID-19. Mortality of patients receiving vitamin C on top of standard-of-care was not lower than patients receiving standard-of-care alone (25.8 vs. 34.7%; RR 0.85, 95% CI 0.57–1.26; p = 0.42).ConclusionsAfter combining results of our observational cohort with those of relevant studies into a meta-analysis of data from 1,807 patients, we found that administration vitamin C as opposed to standard-of-care alone might not be associated with lower of mortality among critically ill patients with COVID-19. Additional evidence is anticipated from relevant large randomized controlled trials which are currently underway.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021276655.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Observational Studymentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis

et al. 2022

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Impact of high‐dose vitamin C on the mortality, severity, and duration of hospital stay in COVID‐19 patients: A meta‐analysis

Bhowmik

Barek

Aziz

et al. 2022

Health Science Reports

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Background and Aims Vitamin C has been predicted to be effective as an antioxidant in treating various ailments, including viral infections such as pervasive coronavirus disease (COVID‐19). With this meta‐analysis, we looked to ascertain the relationship between high‐dose vitamin C administration and mortality, severity, and length of hospitalization of COVID‐19 patients. Methods We collected articles from PubMed, Google Scholar, ScienceDirect, SAGE, and Cochrane databases between January 1, 2020, and May 30, 2022. Odds ratio (ORs) with corresponding 95% confidence interval (CI) and p value were calculated to assess the connection of high‐dose vitamin C in COVID‐19 patients' mortality and severity. The length of hospitalization was calculated and pooled with the mean difference (MD), 95% CI, and p value. Review manager 5.3 was used to carry out this meta‐analysis. Results This meta‐analysis included 15 complete studies involving 2125 COVID‐19 patients. Our study demonstrated a significant correlation between vitamin C consumption and death. Vitamin C consumption significantly reduces mortality risk with COVID‐19 patients (OR = 0.54, 95% CI = 0.42–0.69, p < 0.00001). Furthermore, there was a link between the severity of COVID‐19 and the intake of vitamin C. Patients who consumed vitamin C showed 0.63 times less severity than those who did not take vitamin C (OR = 0.63, 95% CI = 0.43–0.94, p = 0.02). Patients taking vitamin C spent slightly more time in hospital than those who did not take vitamin C (MD = 0.19, 95% CI = −1.57 to 1.96, p = 0.83). Conclusions During COVID‐19, there was a substantial advantage in taking supplementary vitamin C, at least in terms of severity and mortality.

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New randomized controlled trials on micronutrients in critical care nutrition: A narrative review

Halim,

Huang,

Lee

et al. 2024

Nut in Clin Prac

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There has been increasing interest in the role of micronutrient supplementation in critical care. This narrative review summarizes the recent studies on micronutrients in critically ill patients. We searched two databases for primary randomized controlled trials that investigated the effects of micronutrient supplementation in patients with critical illness published from January 2021 to August 2023. Personal files, reference lists of included studies, and previous reviews were also screened. Twelve studies reported on vitamin C, four studies on vitamin D, three studies on thiamin, two studies on multivitamins, and one study on cobalamin. The therapeutic effects of vitamin C appear mixed, although vitamin C monotherapy appears more promising than vitamin C combination therapy. Intramuscular administration of vitamin D appeared to lower mortality, mechanical ventilation duration, and intensive care unit stay, whereas enteral administration showed limited clinical benefits. Intravenous thiamin was not associated with improved outcomes in patients with septic shock or hypophosphatemia. Preliminary evidence suggests reduced vasopressor dose with cobalamin. Decreased disease severity and hospital stay in patients with COVID‐19 with vitamins A–E requires further investigation, whereas providing solely B‐group vitamins did not demonstrate therapeutic effects. It is currently premature to endorse the provision of high‐dose micronutrients in critical illness to improve clinical outcomes. This review may help to inform the design of future trials that will help better elucidate the optimal dosage and form of micronutrients, methods of administration, and subgroups of patients with critical illness who may most benefit.

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The effect of supplementation with vitamins A, B, C, D, and E on disease severity and inflammatory responses in patients with COVID-19: a randomized clinical trial

Cited by 41 publications

References 30 publications

Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis

Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis

Impact of high‐dose vitamin C on the mortality, severity, and duration of hospital stay in COVID‐19 patients: A meta‐analysis

New randomized controlled trials on micronutrients in critical care nutrition: A narrative review

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