The effect of vitamin C in adults with sepsis: a meta-analysis of randomized controlled trials

Xing Luo; Youfeng Zhu; Rui Zhang; JianQiu Zhu; Huanming Kuang; Yuebin Shao; Xinmin Guo; Bo Ning

doi:10.3389/fmed.2023.1244484

The effect of vitamin C in adults with sepsis: a meta-analysis of randomized controlled trials

Front Med (Lausanne). 2023 Aug 31:10:1244484. doi: 10.3389/fmed.2023.1244484. eCollection 2023.

Authors

Xing Luo¹, Youfeng Zhu¹, Rui Zhang¹, JianQiu Zhu¹, Huanming Kuang¹, Yuebin Shao², Xinmin Guo³, Bo Ning⁴

Affiliations

¹ Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
² Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
³ Department of Ultrasonography, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
⁴ Department of Neurosurgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.

Abstract

Background: The effect of intravenous (IV) vitamin C in the treatment of sepsis remains controversial. We aimed to explore the clinical efficacy of vitamin C in the treatment of sepsis.

Methods: Electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched from inception through November 15th, 2022, for randomized controlled trials evaluating the effect of IV vitamin C treatment in patients with sepsis. The primary outcome was short-term mortality, secondary outcomes included duration of vasopressor use, length of intensive care unit (ICU) stay, and Sequential Organ Failure Assessment (SOFA) score after vitamin C treatment. Subgroup analyses were performed based on the dose and duration of IV vitamin C and region to determine whether vitamin C benefited patients with sepsis.

Results: A total of 10 studies including 1,426 patients fulfilled the predefined criteria and were analyzed. Overall, there were no significant differences between the vitamin C group and the control group regarding short-term mortality [odds ratio (OR), 0.61; 95% confidence interval (CI) 0.37-1.01; p = 0.05], ICU length of stay [mean difference (MD), -1.24; 95% CI -3.54 to 1.05, p = 0.29] and SOFA score (MD, -0.85, 95% CI -2.38 to 0.67, p = 0.27). However, vitamin C significantly reduced the duration of vasopressor use (MD, -14.36, 95% CI -26.11 to -2.61, p = 0.02). Furthermore, subgroup analysis found that in developing countries, vitamin C was associated with a significant reduction in short-term mortality (OR, 0.33; 95% CI 0.12-0.90; p = 0.03), duration of vasopressor use (MD, -24.37, 95% CI -33.72 to -15.02, p < 0.001) and SOFA score (MD, -2.55, 95% CI -4.81 to -0.28, p = 0.03).

Conclusion: In our study, vitamin C administration for sepsis patients was not associated with a significant reduction in short-term mortality, length of ICU stay or SOFA score. However, we observed that vitamin C could reduce the duration of vasopressor use. Furthermore, sepsis patients in developing countries may benefit more from vitamin C administration than those in developed countries.Systematic review registration: Identifier CRD42022380958, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=380958.

Keywords: meta-analysis; mortality; sepsis; treatment; vitamin C.

Publication types

Review