Brown Jonathan, Robertson Cassie, Sevilla Luis, Garza Jorge, Rashid Hytham, Benitez Ana C, Shipotko Mikhail, Ali Zuhair
Internal Medicine, University of Houston College of Medicine; HCA Houston Healthcare Kingwood, Kingwood, USA.
Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.
Cureus. 2022 Dec 23;14(12):e32886. doi: 10.7759/cureus.32886. eCollection 2022 Dec.
Sepsis is a substantial healthcare burden, and its management continues to be a major challenge. Prior studies demonstrate conflicting evidence regarding the utility of vitamin C in sepsis. This systematic review and meta-analysis aim to collect data among critically ill patients (sepsis/septic shock), comparing the efficacy of parenteral vitamin C with standard care. A literature review was conducted using databases including PubMed, Web of Science, Google Scholar, and the Cochrane Library to identify randomized controlled trials (RCTs) and observational studies comparing intravenous vitamin C alone or in combination with thiamine or glucocorticoids to the standard of care. We identified 11 RCTs and seven retrospective cohort studies. The primary outcome was 28-day mortality. Secondary outcomes included intensive care unit (ICU) length of stay, change in Sequential Organ Failure Assessment (SOFA) score, duration of vasopressor use, and duration of mechanical ventilation. A total of 18 studies with 4078 patients were included in our final analysis. Overall, we found no mortality reduction in patients treated with vitamin C compared to standard of care (odds ratio (OR) 0.92; 95% confidence interval (CI) 0.78 to 1.09; p = 0.34). Studies that reported a change in SOFA scores, ICU length of stay, duration of mechanical ventilation, or duration of vasopressor use did not show any significant difference between groups. Subgroup analysis with RCT versus observational studies and vitamin C dosage regimens did not show any difference. Among patients with sepsis or septic shock, treatment with vitamin C was not associated with a reduction in mortality, ICU length of stay, change in SOFA score, duration of vasopressor use, or duration of mechanical ventilation. Further studies are needed to demonstrate the potential role of vitamin C in the management of sepsis.
脓毒症是一项沉重的医疗负担，其管理仍然是一项重大挑战。先前的研究表明，关于维生素C在脓毒症中的效用存在相互矛盾的证据。本系统评价和荟萃分析旨在收集危重症患者（脓毒症/脓毒性休克）的数据，比较肠外维生素C与标准治疗的疗效。使用包括PubMed、科学网、谷歌学术和考克兰图书馆在内的数据库进行文献综述，以识别将静脉注射维生素C单独使用或与硫胺素或糖皮质激素联合使用与标准治疗进行比较的随机对照试验（RCT）和观察性研究。我们识别出11项RCT和7项回顾性队列研究。主要结局为28天死亡率。次要结局包括重症监护病房（ICU）住院时间、序贯器官衰竭评估（SOFA）评分的变化、血管升压药使用时间和机械通气时间。我们的最终分析纳入了总共18项研究中的4078例患者。总体而言，我们发现与标准治疗相比，接受维生素C治疗的患者死亡率没有降低（比值比（OR）0.92；95%置信区间（CI）0.78至1.09；p = 0.34）。报告SOFA评分、ICU住院时间、机械通气时间或血管升压药使用时间变化的研究未显示组间有任何显著差异。RCT与观察性研究以及维生素C剂量方案的亚组分析未显示任何差异。在脓毒症或脓毒性休克患者中，维生素C治疗与死亡率降低、ICU住院时间、SOFA评分变化、血管升压药使用时间或机械通气时间无关。需要进一步的研究来证明维生素C在脓毒症管理中的潜在作用。
