Wacker et al, Who Conclude That Vitamin C Monotherapy Failed to Significantly Reduce Mortality in Septic Shock Patients: Beware of Potential Confounding Factors!

Intravenous vitamin C in adults with sepsis in the intensive care unit: still LOV’IT?

“…Some demonstrated benefits including lower mortality, less organ dysfunction and reduced duration on vasopressor support in those patients receiving high-dose vitamin C [ 7 ]. None of these trials showed evidence of harm of high-dose vitamin C in septic or non-septic critically ill patients [ 8 ], with exception of one study using a prolonged continuous infusion of vitamin C that indicated an increase in acute kidney injury (AKI) [ 9 ]. No evidence of increased AKI was observed in LOVIT.…”

The authors reply

“…No significant difference in either outcome was found; however, this may in part be attributable to the small reduction in power for this subgroup analysis. We hope these explorations provide some insight in the important question raised by Honore et al (1).…”

“…To the Editor: W e read with immense interest the article by Wisløff-Aase et al (1) published in the recent issue of Critical Care Medicine, in which the authors have found a reversible diastolic left ventricular dysfunction secondary to moderate hypothermia in patients undergoing cardiopulmonary bypass. However, a few comments that we would like to add are:…”

“…The authors reply: W e thank Honore et al (1) for their insightful commentary on our article (2) recently published in Critical Care Medicine. In their letter, they present a thoughtful argument that a higher dose of IV vitamin C should be administered for patients on renal replacement therapy (RRT) in studies of vitamin C therapy for septic shock.…”

“…In their letter, Honore et al (1) cite a number of studies that demonstrate the removal of vitamin C from serum during RRT, including one study that observed a vitamin C deficiency in a majority of continuous renal replacement therapy recipients despite IV vitamin C repletion of 0.5–1.0 g/d (3). While this certainly demonstrates the potential for RRT to deplete serum vitamin C levels, our trial used a significantly higher vitamin C dose of 6 g/d.…”