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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.


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