Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes
Abstract Background Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1891-y |
| _version_ | 1819077882791591936 |
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| author | Anitra C. Carr Patrice C. Rosengrave Simone Bayer Steve Chambers Jan Mehrtens Geoff M. Shaw |
| author_facet | Anitra C. Carr Patrice C. Rosengrave Simone Bayer Steve Chambers Jan Mehrtens Geoff M. Shaw |
| author_sort | Anitra C. Carr |
| collection | DOAJ |
| description | Abstract Background Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this study we have assessed plasma vitamin C concentrations in critically ill patients relative to infection status (septic shock or non-septic) and level of inflammation (C-reactive protein concentrations). Vitamin C status was also assessed relative to daily enteral and parenteral intakes to determine if standard intensive care unit (ICU) nutritional support is adequate to meet the vitamin C needs of critically ill patients. Methods Forty-four critically ill patients (24 with septic shock, 17 non-septic, 3 uncategorised) were recruited from the Christchurch Hospital Intensive Care Unit. We measured concentrations of plasma vitamin C and a pro-inflammatory biomarker (C-reactive protein) daily over 4 days and calculated patients’ daily vitamin C intake from the enteral or total parenteral nutrition they received. We compared plasma vitamin C and C-reactive protein concentrations between septic shock and non-septic patients over 4 days using a mixed effects statistical model, and we compared the vitamin C status of the critically ill patients with known vitamin C bioavailability data using a four-parameter log-logistic response model. Results Overall, the critically ill patients exhibited hypovitaminosis C (i.e., < 23 μmol/L), with a mean plasma vitamin C concentration of 17.8 ± 8.7 μmol/L; of these, one-third had vitamin C deficiency (i.e., < 11 μmol/L). Patients with hypovitaminosis C had elevated inflammation (C-reactive protein levels; P < 0.05). The patients with septic shock had lower vitamin C concentrations and higher C-reactive protein concentrations than the non-septic patients (P < 0.05). Nearly 40% of the septic shock patients were deficient in vitamin C, compared with 25% of the non-septic patients. These low vitamin C levels were apparent despite receiving recommended intakes via enteral and/or parenteral nutritional therapy (mean 125 mg/d). Conclusions Critically ill patients have low vitamin C concentrations despite receiving standard ICU nutrition. Septic shock patients have significantly depleted vitamin C levels compared with non-septic patients, likely resulting from increased metabolism due to the enhanced inflammatory response observed in septic shock. |
| first_indexed | 2024-12-21T19:04:16Z |
| format | Article |
| id | doaj.art-afbb7e82125445ccb7ae00a9d6dd22b5 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-21T19:04:16Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-afbb7e82125445ccb7ae00a9d6dd22b52022-12-21T18:53:24ZengBMCCritical Care1364-85352017-12-0121111010.1186/s13054-017-1891-yHypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakesAnitra C. Carr0Patrice C. Rosengrave1Simone Bayer2Steve Chambers3Jan Mehrtens4Geoff M. Shaw5Department of Pathology, University of Otago, ChristchurchDepartment of Pathology, University of Otago, ChristchurchDepartment of Pathology, University of Otago, ChristchurchDepartment of Pathology, University of Otago, ChristchurchDepartment of Intensive Care Medicine, Christchurch HospitalDepartment of Intensive Care Medicine, Christchurch HospitalAbstract Background Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this study we have assessed plasma vitamin C concentrations in critically ill patients relative to infection status (septic shock or non-septic) and level of inflammation (C-reactive protein concentrations). Vitamin C status was also assessed relative to daily enteral and parenteral intakes to determine if standard intensive care unit (ICU) nutritional support is adequate to meet the vitamin C needs of critically ill patients. Methods Forty-four critically ill patients (24 with septic shock, 17 non-septic, 3 uncategorised) were recruited from the Christchurch Hospital Intensive Care Unit. We measured concentrations of plasma vitamin C and a pro-inflammatory biomarker (C-reactive protein) daily over 4 days and calculated patients’ daily vitamin C intake from the enteral or total parenteral nutrition they received. We compared plasma vitamin C and C-reactive protein concentrations between septic shock and non-septic patients over 4 days using a mixed effects statistical model, and we compared the vitamin C status of the critically ill patients with known vitamin C bioavailability data using a four-parameter log-logistic response model. Results Overall, the critically ill patients exhibited hypovitaminosis C (i.e., < 23 μmol/L), with a mean plasma vitamin C concentration of 17.8 ± 8.7 μmol/L; of these, one-third had vitamin C deficiency (i.e., < 11 μmol/L). Patients with hypovitaminosis C had elevated inflammation (C-reactive protein levels; P < 0.05). The patients with septic shock had lower vitamin C concentrations and higher C-reactive protein concentrations than the non-septic patients (P < 0.05). Nearly 40% of the septic shock patients were deficient in vitamin C, compared with 25% of the non-septic patients. These low vitamin C levels were apparent despite receiving recommended intakes via enteral and/or parenteral nutritional therapy (mean 125 mg/d). Conclusions Critically ill patients have low vitamin C concentrations despite receiving standard ICU nutrition. Septic shock patients have significantly depleted vitamin C levels compared with non-septic patients, likely resulting from increased metabolism due to the enhanced inflammatory response observed in septic shock.http://link.springer.com/article/10.1186/s13054-017-1891-yIntensive careVitamin CHypovitaminosis CSepsisCritical illnessC-reactive protein |
| spellingShingle | Anitra C. Carr Patrice C. Rosengrave Simone Bayer Steve Chambers Jan Mehrtens Geoff M. Shaw Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes Critical Care Intensive care Vitamin C Hypovitaminosis C Sepsis Critical illness C-reactive protein |
| title | Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes |
| title_full | Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes |
| title_fullStr | Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes |
| title_full_unstemmed | Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes |
| title_short | Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes |
| title_sort | hypovitaminosis c and vitamin c deficiency in critically ill patients despite recommended enteral and parenteral intakes |
| topic | Intensive care Vitamin C Hypovitaminosis C Sepsis Critical illness C-reactive protein |
| url | http://link.springer.com/article/10.1186/s13054-017-1891-y |
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