Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital OWL, University of Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, Haus Gilead I, 33617, Bielefeld, Germany.
Institute for Diagnostic and Interventional Radiology, Protestant Hospital of the Bethel Foundation, Bielefeld, Germany.
Crit Care. 2021 Jan 6;25(1):17. doi: 10.1186/s13054-020-03438-9.
Supplementation of vitamin C in septic patients remains controversial despite eight large clinical trials published only in 2020. We aimed to evaluate the evidence on potential effects of vitamin C treatment on mortality in adult septic patients.
Data search included PubMed, Web of Science, and the Cochrane Library. A meta-analysis of eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only studies with valid classifications of sepsis and intravenous vitamin C treatment (alone or combined with hydrocortisone/thiamine) were included.
A total of 17 studies including 3133 patients fulfilled the predefined criteria and were analyzed. Pooled analysis indicated no mortality reduction in patients treated with vitamin C when compared to reference (risk difference - 0.05 [95% CI - 0.11 to - 0.01]; p = 0.08; p for Cochran Q = 0.002; I = 56%). Notably, subgroup analyses revealed an improved survival, if vitamin C treatment was applied for 3-4 days (risk difference, - 0.10 [95% CI - 0.19 to - 0.02]; p = 0.02) when compared to patients treated for 1-2 or > 5 days. Also, timing of the pooled mortality assessment indicated a reduction concerning short-term mortality (< 30 days; risk difference, - 0.08 [95% CI - 0.15 to - 0.01]; p = 0.02; p for Cochran Q = 0.02; I = 63%). Presence of statistical heterogeneity was noted with no sign of significant publication bias.
Although vitamin C administration did not reduce pooled mortality, patients may profit if vitamin C is administered over 3 to 4 days. Consequently, further research is needed to identify patient subgroups that might benefit from intravenous supplementation of vitamin C.
尽管 2020 年发表了八项大型临床试验，但败血症患者补充维生素 C 的问题仍存在争议。我们旨在评估维生素 C 治疗对成年败血症患者死亡率的潜在影响的证据。
数据检索包括 PubMed、Web of Science 和 Cochrane 图书馆。根据 PRISMA 声明对符合条件的同行评议研究进行荟萃分析。仅纳入有明确败血症分类和静脉用维生素 C 治疗（单独或联合氢化可的松/硫胺素）的研究。
共有 17 项研究，包括 3133 例患者，符合既定标准并进行了分析。汇总分析表明，与对照组相比，维生素 C 治疗并未降低患者死亡率（风险差异-0.05 [95% CI -0.11 至-0.01]；p=0.08；Cochran Q 检验 p 值=0.002；I²=56%）。值得注意的是，如果维生素 C 治疗持续 3-4 天，与治疗 1-2 天或>5 天的患者相比，生存情况得到改善（风险差异-0.10 [95% CI -0.19 至-0.02]；p=0.02）。此外，荟萃分析死亡率评估的时间表明，与短期死亡率（<30 天；风险差异-0.08 [95% CI -0.15 至-0.01]；p=0.02；Cochran Q 检验 p 值=0.02；I²=63%）相关时，死亡率有所降低。注意到存在统计学异质性，但没有明显的发表偏倚迹象。
虽然维生素 C 给药并未降低汇总死亡率，但如果维生素 C 给药持续 3 至 4 天，患者可能会受益。因此，需要进一步研究以确定可能从静脉补充维生素 C 中受益的患者亚组。
