The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials
Abstract Background To update a meta-analysis of randomized controlled trials (RCTs) and further explore the outcome of IV vitamin C (IVVC) administration in sepsis or septic shock patients. Methods This study is a meta-analysis of RCTs. The RCTs of vitamin C therapy in sepsis or septic shock were s...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04392-y |
| _version_ | 1797864583921139712 |
|---|---|
| author | Baofang Liang Jianwei Su Hanquan Shao Huiying Chen Baocheng Xie |
| author_facet | Baofang Liang Jianwei Su Hanquan Shao Huiying Chen Baocheng Xie |
| author_sort | Baofang Liang |
| collection | DOAJ |
| description | Abstract Background To update a meta-analysis of randomized controlled trials (RCTs) and further explore the outcome of IV vitamin C (IVVC) administration in sepsis or septic shock patients. Methods This study is a meta-analysis of RCTs. The RCTs of vitamin C therapy in sepsis or septic shock were searched in PubMed, EMBASE and Clinical Trials.gov from inception to January 16, 2023. We registered the protocol with PROSPERO (CRD42022354875). The primary outcome was delta Sequential Organ Failure Assessment (SOFA) score at 72–96 h. Two reviewers independently assessed RCTs according to eligibility criteria: (1) study type: RCT; (2) patient population: patients ≥ 18 years with sepsis or septic shock; (3) intervention: IVVC at any doses as monotherapy or combined with thiamine or and hydrocortisone compared with standard of care, no intervention or placebo (defined as control group); (4) the RCT described short-term mortality or SOFA score. Then, two authors independently extracted related information from RCTs. Results Eighteen RCTs (n = 3364 patients) were identified in this meta-analysis. There were significant effects in the delta SOFA score from baseline to 72–96 h (MD, − 0.62; 95% CI, − 1.00 to − 0.25; p = 0.001) and the duration of vasopressor use (MD, − 15.07; 95% CI, − 21.59 to − 8.55; p < 0.00001) with IVVC therapy. Treatment with IVVC was not shown to improve short-term mortality (OR, 0.89; 95% CI, 0.77 to 1.04; p = 0.14); nevertheless, dose at 25–100 mg/kg/d subgroup associated with a significant reduction in short-term mortality (OR, 0.80; 95% CI, 0.65 to 0.97; p = 0.03). An increase adverse event was observed in IVVC therapy (OR, 1.98; 95% CI, 1.06 to 3.68; p = 0.03). Conclusion In this meta-analysis, IVVC in sepsis or septic shock patients significantly improved delta SOFA score and reduced the duration of vasopressor use, whereas it was not associated with reduction in short-term mortality and had higher adverse events. |
| first_indexed | 2024-04-09T22:55:21Z |
| format | Article |
| id | doaj.art-b59ffaef88944c86a83c47276c229a55 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T22:55:21Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-b59ffaef88944c86a83c47276c229a552023-03-22T11:20:58ZengBMCCritical Care1364-85352023-03-0127111410.1186/s13054-023-04392-yThe outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trialsBaofang Liang0Jianwei Su1Hanquan Shao2Huiying Chen3Baocheng Xie4Department of Healthcare-associated Infection Management, Affiliated Dongguan Hospital, Southern Medical UniversityDepartment of Clinical Pharmacy, Dongguan Tungwah HospitalDepartment of Critical Care Medicine, Affiliated Dongguan Hospital, Southern Medical UniversityDepartment of Critical Care Medicine, Affiliated Dongguan Hospital, Southern Medical UniversityDepartment of Pharmacy, Affiliated Dongguan Hospital, Southern Medical UniversityAbstract Background To update a meta-analysis of randomized controlled trials (RCTs) and further explore the outcome of IV vitamin C (IVVC) administration in sepsis or septic shock patients. Methods This study is a meta-analysis of RCTs. The RCTs of vitamin C therapy in sepsis or septic shock were searched in PubMed, EMBASE and Clinical Trials.gov from inception to January 16, 2023. We registered the protocol with PROSPERO (CRD42022354875). The primary outcome was delta Sequential Organ Failure Assessment (SOFA) score at 72–96 h. Two reviewers independently assessed RCTs according to eligibility criteria: (1) study type: RCT; (2) patient population: patients ≥ 18 years with sepsis or septic shock; (3) intervention: IVVC at any doses as monotherapy or combined with thiamine or and hydrocortisone compared with standard of care, no intervention or placebo (defined as control group); (4) the RCT described short-term mortality or SOFA score. Then, two authors independently extracted related information from RCTs. Results Eighteen RCTs (n = 3364 patients) were identified in this meta-analysis. There were significant effects in the delta SOFA score from baseline to 72–96 h (MD, − 0.62; 95% CI, − 1.00 to − 0.25; p = 0.001) and the duration of vasopressor use (MD, − 15.07; 95% CI, − 21.59 to − 8.55; p < 0.00001) with IVVC therapy. Treatment with IVVC was not shown to improve short-term mortality (OR, 0.89; 95% CI, 0.77 to 1.04; p = 0.14); nevertheless, dose at 25–100 mg/kg/d subgroup associated with a significant reduction in short-term mortality (OR, 0.80; 95% CI, 0.65 to 0.97; p = 0.03). An increase adverse event was observed in IVVC therapy (OR, 1.98; 95% CI, 1.06 to 3.68; p = 0.03). Conclusion In this meta-analysis, IVVC in sepsis or septic shock patients significantly improved delta SOFA score and reduced the duration of vasopressor use, whereas it was not associated with reduction in short-term mortality and had higher adverse events.https://doi.org/10.1186/s13054-023-04392-yVitamin CSepsisSeptic shockRandomized controlled trialsMortalityMeta-analysis |
| spellingShingle | Baofang Liang Jianwei Su Hanquan Shao Huiying Chen Baocheng Xie The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials Critical Care Vitamin C Sepsis Septic shock Randomized controlled trials Mortality Meta-analysis |
| title | The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials |
| title_full | The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials |
| title_fullStr | The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials |
| title_full_unstemmed | The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials |
| title_short | The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials |
| title_sort | outcome of iv vitamin c therapy in patients with sepsis or septic shock a meta analysis of randomized controlled trials |
| topic | Vitamin C Sepsis Septic shock Randomized controlled trials Mortality Meta-analysis |
| url | https://doi.org/10.1186/s13054-023-04392-y |
| work_keys_str_mv | AT baofangliang theoutcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT jianweisu theoutcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT hanquanshao theoutcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT huiyingchen theoutcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT baochengxie theoutcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT baofangliang outcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT jianweisu outcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT hanquanshao outcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT huiyingchen outcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials AT baochengxie outcomeofivvitaminctherapyinpatientswithsepsisorsepticshockametaanalysisofrandomizedcontrolledtrials |