Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis
BackgroundAn 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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2023.1211194/full |
| _version_ | 1797754398393237504 |
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| author | Huoyan Liang Huoyan Liang Qingqing Mu Wenju Sun Liming Liu Simin Qiu Zili Xu Yuqing Cui Yan Yan Tongwen Sun Tongwen Sun |
| author_facet | Huoyan Liang Huoyan Liang Qingqing Mu Wenju Sun Liming Liu Simin Qiu Zili Xu Yuqing Cui Yan Yan Tongwen Sun Tongwen Sun |
| author_sort | Huoyan Liang |
| collection | DOAJ |
| description | BackgroundAn 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.MethodsWe 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).ResultsTwenty-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.ConclusionsIVVC 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 registrationhttps://inplasy.com/. |
| first_indexed | 2024-03-12T17:32:55Z |
| format | Article |
| id | doaj.art-c2b23246cf5e4b2d92f6a71b7095d124 |
| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-03-12T17:32:55Z |
| publishDate | 2023-08-01 |
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| spelling | doaj.art-c2b23246cf5e4b2d92f6a71b7095d1242023-08-04T15:59:47ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2023-08-011010.3389/fnut.2023.12111941211194Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysisHuoyan Liang0Huoyan Liang1Qingqing Mu2Wenju Sun3Liming Liu4Simin Qiu5Zili Xu6Yuqing Cui7Yan Yan8Tongwen Sun9Tongwen Sun10General 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, ChinaAcademy of Medical Sciences, Zhengzhou University, Zhengzhou, ChinaAcademy of Clinical Medicine, Zhengzhou University, Zhengzhou, ChinaGeneral 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, ChinaGeneral 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, ChinaAcademy of Clinical Medicine, Zhengzhou University, Zhengzhou, ChinaAcademy of Clinical Medicine, Zhengzhou University, Zhengzhou, ChinaGeneral 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, ChinaGeneral 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, ChinaGeneral 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, ChinaAcademy of Medical Sciences, Zhengzhou University, Zhengzhou, ChinaBackgroundAn 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.MethodsWe 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).ResultsTwenty-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.ConclusionsIVVC 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 registrationhttps://inplasy.com/.https://www.frontiersin.org/articles/10.3389/fnut.2023.1211194/fullvitamin Csepsisseptic shockhydrocortisonemeta-analysis |
| spellingShingle | Huoyan Liang Huoyan Liang Qingqing Mu Wenju Sun Liming Liu Simin Qiu Zili Xu Yuqing Cui Yan Yan Tongwen Sun Tongwen Sun Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis Frontiers in Nutrition vitamin C sepsis septic shock hydrocortisone meta-analysis |
| title | Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis |
| title_full | Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis |
| title_fullStr | Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis |
| title_full_unstemmed | Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis |
| title_short | Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis |
| title_sort | effect of intravenous vitamin c on adult septic patients a systematic review and meta analysis |
| topic | vitamin C sepsis septic shock hydrocortisone meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2023.1211194/full |
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