NEJM
June 23, 2022
Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit.
Mazen Kherallah
Summarized by:
What was the research question?
Does the use of intravenous vitamin C in critically ill adults with sepsis who are receiving vasopressor therapy, result in reduction of death and organ dysfunction?
How did they do it?
A randomized, placebo-controlled trial in 35 adult medical–surgical ICUs in Canada, France, and New Zealand.
872 ICU septic patients who were receiving vasopressor therapy and had been in the ICU for less than 24 hours, were randomized to receive an infusion of either vitamin C (50 mg/kg) (435 patients) or matched placebo (437 patients) administered every 6 hours for up to 96 hours.
The primary outcome was a 28-day composite of death or persistent organ dysfunction (defined as the use of vasopressors, invasive mechanical ventilation, or new renal-replacement therapy).
What did they find?
The primary outcome was significantly higher in the vitamin C group compared to the placebo group (44.5% vs. 38.5%, risk ratio, 1.21; 95% CI, 1.04 to 1.40; P=0.01).
28-day mortality was 35.4% in the vitamin C group and 31.6% in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40), and persistent organ dysfunction at 28 days was 9.1% and 6.9%, respectively (risk ratio, 1.30; 95% CI, 0.83 to 2.05).
There were no safety issues in the predefined safety outcome (stage 3 acute kidney injury, acute hemolysis, and hypoglycemic episodes).
Are there any limitations?
Does not exclude benefit in selected ARDS population.
Results are not generalizable to middle or low-income countries.
The secondary analysis does not determine mechanism of harm.
What does it mean?
Intravenous vitamin C therapy results in an increased risk of death or persistent organ dysfunction at 28 days in patients with sepsis who are receiving vasopressor therapy with no clear mechanism for harm.
Results do not support the use of intervenors vitamin C in sepsis.