Vitamin C alone does not improve treatment outcomes in mechanically ventilated patients with severe sepsis or septic shock: a retrospective cohort study - PubMed (original) (raw)
Vitamin C alone does not improve treatment outcomes in mechanically ventilated patients with severe sepsis or septic shock: a retrospective cohort study
Jee Hwan Ahn et al. J Thorac Dis. 2019 Apr.
Abstract
Background: Vitamin C has shown several beneficial effects on sepsis in preclinical studies. However, clinical data supporting these reports are scarce. This study aimed to evaluate whether adjunctive intravenous vitamin C therapy could reduce hospital mortality in patients with severe sepsis or septic shock requiring mechanical ventilation.
Methods: For this retrospective cohort study, consecutive medical ICU patients with severe sepsis or septic shock requiring mechanical ventilation were included. The study patients were classified into the vitamin C or control groups depending on the administration of intravenous vitamin C (2 g every 8 hours). The primary outcome was hospital mortality.
Results: Thirty-five patients in the vitamin C group and 40 patients in the control group were included. The two groups were comparable in regards to the baseline characteristics at ICU admission. The hospital mortality was 46% (16 of 35 patients) in the vitamin C group and 40% (16 of 40 patients) in the control group, showing a statistically nonsignificant difference (P=0.62). The mortality at 90 days after ICU admission (60% vs. 48%) did not significantly differ between groups. The median time to shock reversal was 3 days [interquartile range (IQR), 2 to 5 days] in both groups. The changes in the Sepsis-related Organ Failure Assessment (SOFA) scores during the first 4 ICU days were -1.4±3.3 and -1.4±3.0 in the vitamin C and control groups, respectively.
Conclusions: Adjunctive intravenous vitamin C therapy alone did not reduce hospital mortality in mechanically ventilated patients with severe sepsis or septic shock.
Keywords: Sepsis; mortality; septic shock; vitamin C.
Conflict of interest statement
Conflicts of Interest: The authors have no conflicts of interest to declare.
Figures
Figure 1
A flowchart illustrating the inclusion and exclusion of the study patients
Figure 2
The Kaplan-Meier curves for cumulative survival of the study patients depending on the administration of adjunctive intravenous vitamin C therapy. P=0.2 between the vitamin C and control groups.
Figure 3
The cumulative incidence function plot of time to shock reversal in the vitamin C and control groups. P=0.81 for comparison between the two groups by treating death as a competing risk.
Figure 4
The effect of intravenous vitamin C on vasopressor requirement and the SOFA score during the first 4 ICU days. (A) Daily vasopressor requirement in the vitamin C and control groups, calculated in norepinephrine equivalent doses. P=0.82 for intergroup difference in dose over time; (B) serial changes in SOFA scores from ICU day 1 according to treatment group. P=0.46 for intergroup difference in the score change over time. SOFA, Sepsis-related Organ Failure Assessment.
References
- Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med 2016;193:259-72. - PubMed
- Gaieski DF, Edwards JM, Kallan MJ, et al. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med 2013;41:1167-74. - PubMed
- Lee CC, Yo CH, Lee MG, et al. Adult sepsis—a nationwide study of trends and outcomes in a population of 23 million people. J Infect 2017;75:409-19. - PubMed
- Kaukonen KM, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014;311:1308-16. - PubMed
LinkOut - more resources
Full Text Sources