Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome

Chiscano-Camón, Luis; Ruiz‐Rodríguez, Juan Carlos; Ruiz‐Sanmartin, Adolf; Roca, Oriol; Ferrer, Ricard

doi:10.1186/s13054-020-03249-y

Cited by 97 publications

(88 citation statements)

References 5 publications

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“…Despite a significant increase when compared to short stayers, vitamin C level in long stayers remained below the inferior normal value. In a recent paper, Chiscano-Camón et al [33] reported that undetectable vitamin C levels were observed in 94.4% of COVID-19 patients 17.5 days after ICU hospitalization. In our study, such a vitamin C deficiency indicated that intakes of this antioxidant given at nutritional doses as recommended by ESPEN guidelines [34] were therefore not sufficient to maintain vitamin C concentration in the reference interval, as already observed in other critically ill patients [35].…”

Section: Antioxidant Analysismentioning

confidence: 98%

“…Associated to increased lipid peroxidation, these observations should therefore create opportunities to explore potential approaches for prevention or treatment by antioxidants, as observed in COVID-19 patients [76][77][78][79][80]. As recently suggested for vitamin C and glutathione [33,47,81], monitoring of OSS should be implemented in COVID-19 critically ill patients, including vitamin C, GSH in association with PSH, and, finally, ROOH in association with the Cu/Zn ratio and CRP.…”

Section: Analysis Of Inflammation Biomarkersmentioning

confidence: 99%

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Oxidative Stress Status in COVID-19 Patients Hospitalized in Intensive Care Unit for Severe Pneumonia. A Pilot Study

et al. 2021

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Background: A key role of oxidative stress has been highlighted in the pathogenesis of COVID-19. However, little has been said about oxidative stress status (OSS) of COVID-19 patients hospitalized in intensive care unit (ICU). Material and Methods: Biomarkers of the systemic OSS included antioxidants (9 assays), trace elements (3 assays), inflammation markers (4 assays) and oxidative damage to lipids (3 assays). Results: Blood samples were drawn after 9 (7–11) and 41 (39–43) days of ICU stay, respectively in 3 and 6 patients. Vitamin C, thiol proteins, reduced glutathione, γ-tocopherol, β-carotene and PAOT® score were significantly decreased compared to laboratory reference values. Selenium concentration was at the limit of the lower reference value. By contrast, the copper/zinc ratio (as a source of oxidative stress) was higher than reference values in 55% of patients while copper was significantly correlated with lipid peroxides (r = 0.95, p < 0.001). Inflammatory biomarkers (C-reactive protein and myeloperoxidase) were significantly increased when compared to normals. Conclusions: The systemic OSS was strongly altered in critically ill COVID-19 patients as evidenced by increased lipid peroxidation but also by deficits in some antioxidants (vitamin C, glutathione, thiol proteins) and trace elements (selenium).

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Section: Antioxidant Analysismentioning

confidence: 98%

Section: Analysis Of Inflammation Biomarkersmentioning

confidence: 99%

Oxidative Stress Status in COVID-19 Patients Hospitalized in Intensive Care Unit for Severe Pneumonia. A Pilot Study

et al. 2021

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“…Hypovitaminosis C was ubiquitous in critically ill patients, and approximately 40% of the patients had a severe deficiency [ 16 ], while the low vitamin C serum level cannot be corrected by oral supplementation due to the issue of pharmacokinetics [ 17 ]. In a latest research, of 18 adult ICU patients COVID-19 who met ARDS criteria, 94.4% had undetectable vitamin C levels and 1 patient had low levels [ 18 ]. Thus, high-dose intravenous vitamin C (HDIVC) was added to the standard therapy of critically ill patients in recent studies, such as sepsis [ 19 – 21 ], ARDS [ 21 , 22 ], cardiac surgery [ 23 ], and burn [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Pilot trial of high-dose vitamin C in critically ill COVID-19 patients

Zhang

Rao

et al. 2021

Ann. Intensive Care

192

240

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Background Few specific medications have been proven effective for the treatment of patients with severe coronavirus disease 2019 (COVID-19). Here, we tested whether high-dose vitamin C infusion was effective for severe COVID-19. Methods This randomized, controlled, clinical trial was performed at 3 hospitals in Hubei, China. Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ICU were randomly assigned in as 1:1 ratio to either the high-dose intravenous vitamin C (HDIVC) or the placebo. HDIVC group received 12 g of vitamin C/50 ml every 12 h for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way within 48 h of arrival to ICU. The primary outcome was invasive mechanical ventilation-free days in 28 days (IMVFD28). Secondary outcomes were 28-day mortality, organ failure (Sequential Organ Failure Assessment (SOFA) score), and inflammation progression (interleukin-6). Results Only 56 critical COVID-19 patients were ultimately recruited due to the early control of the outbreak. There was no difference in IMVFD28 between two groups (26.0 [9.0–28.0] in HDIVC vs 22.0 [8.50–28.0] in control, p = 0.57). HDIVC failed to reduce 28-day mortality (P = 0.27). During the 7-day treatment period, patients in the HDIVC group had a steady rise in the PaO2/FiO2 (day 7: 229 vs. 151 mmHg, 95% CI 33 to 122, P = 0.01), which was not observed in the control group. IL-6 in the HDIVC group was lower than that in the control group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P = 0.04) on day 7. Conclusion This pilot trial showed that HDIVC failed to improve IMVFD28, but might show a potential signal of benefit in oxygenation for critically ill patients with COVID-19 improving PaO2/FiO2 even though.

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“…There is much evidence that critically ill patients have reduced plasma levels of vitamin C, which is explained by the increased depletion of the vitamin in their body so that one third of ICU patients may have as low vitamin C levels as vitamin C deficient patients ( 13 , 14 ). In particular, a recent survey found that out of 18 COVID-19 patients, 17 had undetectable vitamin C levels and one patient had a very low level ( 15 ). Another recent study also reported low vitamin C plasma levels in COVID-19 patients, and non-survivors had half the plasma level of survivors ( 16 ).…”

Section: Evidence Indicating That Vitamin C Might Influence Covid-19mentioning

confidence: 99%

Vitamin C and COVID-19

Hemilä

Man

2021

Front. Med.

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In numerous animal studies, vitamin C has prevented and alleviated viral and bacterial infections. In a few dozen placebo-controlled trials with humans, vitamin C has shortened infections caused by respiratory viruses, which indicates that the vitamin can also influence viral infections in humans. In critically ill patients, plasma vitamin C levels are commonly very low. Gram doses of vitamin C are needed to increase the plasma vitamin C levels of critically ill patients to the levels of ordinary healthy people. A meta-analysis of 12 trials with 1,766 patients calculated that vitamin C reduced the length of ICU stay on average by 8%. Another meta-analysis found that vitamin C shortened the duration of mechanical ventilation in ICU patients. Two randomized placebo-controlled trials found statistically significant reduction in the mortality of sepsis patients. The effects of vitamin C on acute respiratory distress syndrome (ARDS) frequently complicating COVID-19 pneumonia should be considered. Vitamin C is a safe and inexpensive essential nutrient.

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Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome

Cited by 97 publications

References 5 publications

Oxidative Stress Status in COVID-19 Patients Hospitalized in Intensive Care Unit for Severe Pneumonia. A Pilot Study

Oxidative Stress Status in COVID-19 Patients Hospitalized in Intensive Care Unit for Severe Pneumonia. A Pilot Study

Pilot trial of high-dose vitamin C in critically ill COVID-19 patients

Vitamin C and COVID-19

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