Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis

Huoyan Liang; Qingqing Mu; Wenju Sun; Liming Liu; Simin Qiu; Zili Xu; Yuqing Cui; Yan Yan; Tongwen Sun

doi:10.3389/fnut.2023.1211194

Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis

Front Nutr. 2023 Aug 3:10:1211194. doi: 10.3389/fnut.2023.1211194. eCollection 2023.

Authors

Huoyan Liang^#^{1

2}, Qingqing Mu^#³, Wenju Sun^#¹, Liming Liu¹, Simin Qiu³, Zili Xu³, Yuqing Cui¹, Yan Yan¹, Tongwen Sun^{1

2}

Affiliations

¹ General Intensive Care Unit, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China.
³ Academy of Clinical Medicine, Zhengzhou University, Zhengzhou, China.

^# Contributed equally.

Abstract

Background: An increasing number of studies indicate that vitamin C (VC) reduces the mortality of adult septic patients, while some articles suggest otherwise. We performed this systematic review and meta-analysis to resolve the discrepancies in reported results concerning the efficacy of VC in septic patients.

Methods: We comprehensively searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled trials for randomized controlled trials (RCTs) evaluating the efficacy of intravenous VC (IVVC) on adult septic patients published from inception to November 28, 2022. The quality of outcomes for eligible studies was assessed using the Recommendations Assessment, Development, and Evaluation methodology. The results were analyzed using the pooled mean difference (MD) or risk ratio (RR) and 95% confidence intervals (CIs).

Results: Twenty-two studies (3,570 adult septic patients) were included. IVVC treatment did not improve 28-day mortality compared to the control group (RR, 0.92; 95% CI, 0.81-1.04; I² = 26%; evidence risk, moderate). IVVC monotherapy decreased mortality (RR, 0.69; 95% CI, 0.52-0.93; I² = 57%), whereas combination therapy did not affect mortality (RR, 1.03; 95% CI, 0.90-1.17; I² =0%). IVVC had a trend to decrease the mortality of septic patients (RR, 0.83; 95% CI, 0.69-1.00; I² = 33%) but did not affect septic shock patients (RR, 1.01; 95% CI, 0.85-1.21; I² = 18%). IVVC reduced the duration of vasopressor use (MD, -8.45; 95% CI, -15.43 to -1.47; evidence risk, very low) but did not influence the incidence of AKI, ICU length of stay, duration of mechanical ventilation.

Conclusions: IVVC treatment did not improve the 28-day mortality in septic patients. Subgroup analysis indicated that VC had a trend to decrease the 28-day mortality in patients with sepsis but not septic shock. IVVC monotherapy, rather than combination therapy, decreased the 28-day mortality in septic patients. The findings imply that Hydrocortisone, Ascorbic acid, Thiamine (HAT) combination therapy is not superior to IVVC monotherapy for septic patients. These findings warrant further confirmation in future studies, which should also investigate the mechanisms underlying the enhanced efficacy of IVVC monotherapy in septic patients.

Systematic review registration: https://inplasy.com/.

Keywords: hydrocortisone; meta-analysis; sepsis; septic shock; vitamin C.

Publication types

Systematic Review