High Dose Intravenous Vitamin C for Preventing The Disease Aggravation of Moderate COVID-19 Pneumonia. A Retrospective Propensity Matched Before-After Study

Bing Zhao; Min Liu; Ping Liu; Yibing Peng; Jun Huang; Mengjiao Li; Yihui Wang; LiLi Xu; Silei Sun; Xing Qi; Yun Ling; Jian Li; Wenhong Zhang; Enqiang Mao; Jieming Qu

doi:10.3389/fphar.2021.638556

High Dose Intravenous Vitamin C for Preventing The Disease Aggravation of Moderate COVID-19 Pneumonia. A Retrospective Propensity Matched Before-After Study

Front Pharmacol. 2021 Apr 22:12:638556. doi: 10.3389/fphar.2021.638556. eCollection 2021.

Authors

Bing Zhao¹, Min Liu², Ping Liu³, Yibing Peng⁴, Jun Huang⁵, Mengjiao Li¹, Yihui Wang¹, LiLi Xu¹, Silei Sun¹, Xing Qi¹, Yun Ling⁶, Jian Li⁷, Wenhong Zhang⁸, Enqiang Mao¹, Jieming Qu⁹

Affiliations

¹ Department of Emergency of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Gastroenterology, Shanghai Public Health Clinical Center, Shanghai, China.
³ Department of Tuberculosis, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
⁴ Department of Laboratory Medicine, Ruijin Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, China.
⁵ Shanghai Institute of Hypertension, Shanghai, China.
⁶ Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai, China.
⁷ Clinical Research Center in Ruijin Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China.
⁸ Department of Infectious Disease of Shanghai Huashan Hospital, Fudan University, Shanghai, China.
⁹ Department of Respiratory and Critical Care Medicine of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Background: Coronavirus disease 2019 (COVID-19) pandemic is continuing to impact multiple countries worldwide and effective treatment options are still being developed. In this study, we investigate the potential of high-dose intravenous vitamin C (HDIVC) in the prevention of moderate COVID-19 disease aggravation. Methods: In this retrospective before-after case-matched clinical study, we compare the outcome and clinical courses of patients with moderate COVID-19 patients who were treated with an HDIVC protocol (intravenous injection of vitamin C, 100 mg/kg/day, 1 g/h, for 7 days from admission) during a one-month period (between March 18 and april 18, 2020, HDIVC group) with a control group treated without the HDIVC protocol during the preceding two months (January 18 to March 18, 2020). Patients in the two groups were matched in a 1:1 ratio according to age and gender. Results: The HDIVC and control groups each comprised 55 patients. For the primary outcomes, there was a significant difference in the number of patients that evolved from moderate to severe type between the two groups (HDIVC: 4/55 vs. control: 12/55, relative risk [RR] = 0.28 [0.08, 0.93], P = 0.03). Compared to the control group, there was a shorter duration of systemic inflammatory response syndrome (SIRS) (P = 0.0004) during the first week and lower SIRS occurrence (2/21 vs 10/22, P = 0.0086) on Day 7 (6-7 days after admission). In addition, HDIVC group had lower C-reactive protein levels (P = 0.005) and higher number of CD4⁺ T cells from Day 0 (on admission) to Day 7 (P = 0.04)." The levels of coagulation indicators, including activated partial thromboplastin time and D-dimer were also improved in the HDIVC compared to the control group on Day 7. Conclusion: HDIVC may be beneficial in limiting disease aggravation in the early stage of COVID-19 pneumonia, which may be related to its improvements on the inflammatory response, immune function and coagulation function. Further randomized controlled trials are required to augment these findings.

Keywords: COVID-19; disease aggravation; inflammatory response; therapy; vitamin C.