Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C
Community-acquired pneumonia (CAP) is characterized by elevated markers of inflammation and oxidative stress and depleted circulating concentrations of the antioxidant nutrient vitamin C. A feasibility trial of intravenous and oral vitamin C supplementation, matched to the timing of intravenous and...
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| Format: | Article |
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MDPI AG
2023-08-01
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| Series: | Antioxidants |
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| Online Access: | https://www.mdpi.com/2076-3921/12/8/1610 |
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| author | Anitra C. Carr Emma Vlasiuk Masuma Zawari Amy Scott-Thomas Malina Storer Michael Maze Stephen T. Chambers |
| author_facet | Anitra C. Carr Emma Vlasiuk Masuma Zawari Amy Scott-Thomas Malina Storer Michael Maze Stephen T. Chambers |
| author_sort | Anitra C. Carr |
| collection | DOAJ |
| description | Community-acquired pneumonia (CAP) is characterized by elevated markers of inflammation and oxidative stress and depleted circulating concentrations of the antioxidant nutrient vitamin C. A feasibility trial of intravenous and oral vitamin C supplementation, matched to the timing of intravenous and oral antibiotic formulations, was carried out and changes in vitamin C status were monitored to determine whether saturating status could be achieved throughout the administration period. Patients with moderate and severe CAP (CURB-65 ≥ 2; <i>n</i> = 75) who were receiving intravenous antimicrobial therapy were randomized to placebo (<i>n</i> = 39) or intravenous vitamin C (2.5 g per 8 h; <i>n</i> = 36) before moving to oral vitamin C (1 g three times daily) when prescribed oral antimicrobials. Blood samples were collected at baseline and then daily whilst in the hospital. Vitamin C concentrations were determined by high-performance liquid chromatography. The inflammatory and infection biomarkers C-reactive protein and procalcitonin were elevated at baseline (158 (61, 277) mg/L and 414 (155, 1708) ng/L, respectively), and vitamin C concentrations were depleted (15 (7, 25) µmol/L). There was an inverse association between vitamin C and C-reactive protein concentrations (<i>r</i> = −0.312, <i>p</i> = 0.01). Within one day of intervention initiation, plasma vitamin C concentrations in the vitamin C group reached median concentrations of 227 (109, 422) µmol/L, and circulating concentrations remained at ≥150 µmol/L for the duration of the intervention, whilst median vitamin C concentrations in the placebo group remained low (≤35 µmol/L). There was a trend toward decreased duration of hospital stay (<i>p</i> = 0.07) and time to clinical stability (<i>p</i> = 0.08) in the vitamin C group. In conclusion, patients with moderate to severe CAP have inadequate plasma vitamin C concentrations for the duration of their hospital stay. The administration of intravenous or oral vitamin C, titrated to match the antimicrobial formulation, provided saturating plasma vitamin C concentrations whilst in the hospital. There were trends toward shorter duration of hospital stay and time to clinical stability. Thus, larger trials assessing the impact of intravenous and oral vitamin C intervention on CAP clinical outcomes are indicated. |
| first_indexed | 2024-03-11T00:10:35Z |
| format | Article |
| id | doaj.art-6eea7e79a85047dabafca0560ff456d0 |
| institution | Directory Open Access Journal |
| issn | 2076-3921 |
| language | English |
| last_indexed | 2024-03-11T00:10:35Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antioxidants |
| spelling | doaj.art-6eea7e79a85047dabafca0560ff456d02023-11-19T00:02:41ZengMDPI AGAntioxidants2076-39212023-08-01128161010.3390/antiox12081610Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin CAnitra C. Carr0Emma Vlasiuk1Masuma Zawari2Amy Scott-Thomas3Malina Storer4Michael Maze5Stephen T. Chambers6Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New ZealandDepartment of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New ZealandDepartment of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New ZealandDepartment of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New ZealandRespiratory Services, Christchurch Hospital, Christchurch 4710, New ZealandRespiratory Services, Christchurch Hospital, Christchurch 4710, New ZealandDepartment of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New ZealandCommunity-acquired pneumonia (CAP) is characterized by elevated markers of inflammation and oxidative stress and depleted circulating concentrations of the antioxidant nutrient vitamin C. A feasibility trial of intravenous and oral vitamin C supplementation, matched to the timing of intravenous and oral antibiotic formulations, was carried out and changes in vitamin C status were monitored to determine whether saturating status could be achieved throughout the administration period. Patients with moderate and severe CAP (CURB-65 ≥ 2; <i>n</i> = 75) who were receiving intravenous antimicrobial therapy were randomized to placebo (<i>n</i> = 39) or intravenous vitamin C (2.5 g per 8 h; <i>n</i> = 36) before moving to oral vitamin C (1 g three times daily) when prescribed oral antimicrobials. Blood samples were collected at baseline and then daily whilst in the hospital. Vitamin C concentrations were determined by high-performance liquid chromatography. The inflammatory and infection biomarkers C-reactive protein and procalcitonin were elevated at baseline (158 (61, 277) mg/L and 414 (155, 1708) ng/L, respectively), and vitamin C concentrations were depleted (15 (7, 25) µmol/L). There was an inverse association between vitamin C and C-reactive protein concentrations (<i>r</i> = −0.312, <i>p</i> = 0.01). Within one day of intervention initiation, plasma vitamin C concentrations in the vitamin C group reached median concentrations of 227 (109, 422) µmol/L, and circulating concentrations remained at ≥150 µmol/L for the duration of the intervention, whilst median vitamin C concentrations in the placebo group remained low (≤35 µmol/L). There was a trend toward decreased duration of hospital stay (<i>p</i> = 0.07) and time to clinical stability (<i>p</i> = 0.08) in the vitamin C group. In conclusion, patients with moderate to severe CAP have inadequate plasma vitamin C concentrations for the duration of their hospital stay. The administration of intravenous or oral vitamin C, titrated to match the antimicrobial formulation, provided saturating plasma vitamin C concentrations whilst in the hospital. There were trends toward shorter duration of hospital stay and time to clinical stability. Thus, larger trials assessing the impact of intravenous and oral vitamin C intervention on CAP clinical outcomes are indicated.https://www.mdpi.com/2076-3921/12/8/1610vitamin Cascorbic acidantioxidantintravenous vitamin Cpneumoniacommunity-acquired pneumonia |
| spellingShingle | Anitra C. Carr Emma Vlasiuk Masuma Zawari Amy Scott-Thomas Malina Storer Michael Maze Stephen T. Chambers Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C Antioxidants vitamin C ascorbic acid antioxidant intravenous vitamin C pneumonia community-acquired pneumonia |
| title | Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C |
| title_full | Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C |
| title_fullStr | Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C |
| title_full_unstemmed | Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C |
| title_short | Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C |
| title_sort | low vitamin c concentrations in patients with community acquired pneumonia resolved with pragmatic administration of intravenous and oral vitamin c |
| topic | vitamin C ascorbic acid antioxidant intravenous vitamin C pneumonia community-acquired pneumonia |
| url | https://www.mdpi.com/2076-3921/12/8/1610 |
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