Liang Huoyan, Mu Qingqing, Sun Wenju, Liu Liming, Qiu Simin, Xu Zili, Cui Yuqing, Yan Yan, Sun Tongwen
General 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, China.
Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China.
Front Nutr. 2023 Aug 3;10:1211194. doi: 10.3389/fnut.2023.1211194. eCollection 2023.
An 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.
We 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).
Twenty-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; = 26%; evidence risk, moderate). IVVC monotherapy decreased mortality (RR, 0.69; 95% CI, 0.52-0.93; = 57%), whereas combination therapy did not affect mortality (RR, 1.03; 95% CI, 0.90-1.17; =0%). IVVC had a trend to decrease the mortality of septic patients (RR, 0.83; 95% CI, 0.69-1.00; = 33%) but did not affect septic shock patients (RR, 1.01; 95% CI, 0.85-1.21; = 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.
IVVC 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.
越来越多的研究表明维生素C（VC）可降低成年脓毒症患者的死亡率，但也有一些文章持相反观点。我们进行了这项系统评价和荟萃分析，以解决关于VC对脓毒症患者疗效的报道结果中的差异。
我们全面检索了MEDLINE、EMBASE和Cochrane对照试验中央注册库，以查找自开始至2022年11月28日发表的评估静脉注射VC（IVVC）对成年脓毒症患者疗效的随机对照试验（RCT）。使用推荐评估、制定和评价方法评估符合条件研究的结果质量。使用合并平均差（MD）或风险比（RR）及95%置信区间（CI）分析结果。
纳入了22项研究（3570例成年脓毒症患者）。与对照组相比，IVVC治疗并未改善28天死亡率（RR，0.92；95%CI，0.81 - 1.04；I² = 26%；证据质量风险，中等）。IVVC单药治疗降低了死亡率（RR，0.69；95%CI，0.52 - 0.93；I² = 57%），而联合治疗未影响死亡率（RR，1.03；95%CI，0.90 - 1.17；I² = 0%）。IVVC有降低脓毒症患者死亡率的趋势（RR，0.83；95%CI，0.69 - 1.00；I² = 33%），但未影响脓毒症休克患者（RR，1.01；95%CI，0.85 - 1.21；I² = 18%）。IVVC缩短了血管活性药物的使用时间（MD， - 8.45；95%CI， - 15.43至 - 1.47；证据质量风险，极低），但未影响急性肾损伤的发生率、重症监护病房住院时间、机械通气时间。
IVVC治疗未改善脓毒症患者的28天死亡率。亚组分析表明，VC有降低脓毒症患者而非脓毒症休克患者28天死亡率的趋势。IVVC单药治疗而非联合治疗降低了脓毒症患者的28天死亡率。这些发现表明，对于脓毒症患者，氢化可的松、维生素C、硫胺素（HAT）联合治疗并不优于IVVC单药治疗。这些发现有待未来研究进一步证实，未来研究还应探究IVVC单药治疗对脓毒症患者疗效增强的潜在机制。
