维生素C对脓毒症成年患者的影响：一项随机对照试验的荟萃分析
The effect of vitamin C in adults with sepsis: a meta-analysis of randomized controlled trials.
作者信息
Luo Xing, Zhu Youfeng, Zhang Rui, Zhu JianQiu, Kuang Huanming, Shao Yuebin, Guo Xinmin, Ning Bo
机构信息
Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
出版信息
Front Med (Lausanne). 2023 Aug 31;10:1244484. doi: 10.3389/fmed.2023.1244484. eCollection 2023.
BACKGROUND
The effect of intravenous (IV) vitamin C in the treatment of sepsis remains controversial. We aimed to explore the clinical efficacy of vitamin C in the treatment of sepsis.
METHODS
Electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched from inception through November 15th, 2022, for randomized controlled trials evaluating the effect of IV vitamin C treatment in patients with sepsis. The primary outcome was short-term mortality, secondary outcomes included duration of vasopressor use, length of intensive care unit (ICU) stay, and Sequential Organ Failure Assessment (SOFA) score after vitamin C treatment. Subgroup analyses were performed based on the dose and duration of IV vitamin C and region to determine whether vitamin C benefited patients with sepsis.
RESULTS
A total of 10 studies including 1,426 patients fulfilled the predefined criteria and were analyzed. Overall, there were no significant differences between the vitamin C group and the control group regarding short-term mortality [odds ratio (OR), 0.61; 95% confidence interval (CI) 0.37-1.01; = 0.05], ICU length of stay [mean difference (MD), -1.24; 95% CI -3.54 to 1.05, = 0.29] and SOFA score (MD, -0.85, 95% CI -2.38 to 0.67, = 0.27). However, vitamin C significantly reduced the duration of vasopressor use (MD, -14.36, 95% CI -26.11 to -2.61, = 0.02). Furthermore, subgroup analysis found that in developing countries, vitamin C was associated with a significant reduction in short-term mortality (OR, 0.33; 95% CI 0.12-0.90; = 0.03), duration of vasopressor use (MD, -24.37, 95% CI -33.72 to -15.02, < 0.001) and SOFA score (MD, -2.55, 95% CI -4.81 to -0.28, = 0.03).
CONCLUSION
In our study, vitamin C administration for sepsis patients was not associated with a significant reduction in short-term mortality, length of ICU stay or SOFA score. However, we observed that vitamin C could reduce the duration of vasopressor use. Furthermore, sepsis patients in developing countries may benefit more from vitamin C administration than those in developed countries. Identifier CRD42022380958, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=380958.
背景
静脉注射维生素C治疗脓毒症的效果仍存在争议。我们旨在探讨维生素C治疗脓毒症的临床疗效。
方法
检索电子数据库（PubMed、Embase、Web of Science和Cochrane图书馆），检索时间从数据库建立至2022年11月15日，以查找评估静脉注射维生素C治疗脓毒症患者效果的随机对照试验。主要结局为短期死亡率，次要结局包括血管升压药使用时长、重症监护病房（ICU）住院时长以及维生素C治疗后的序贯器官衰竭评估（SOFA）评分。根据静脉注射维生素C的剂量、持续时间和地区进行亚组分析，以确定维生素C是否对脓毒症患者有益。
结果
共有10项研究（包括1426例患者）符合预设标准并进行了分析。总体而言，维生素C组和对照组在短期死亡率[比值比（OR），0.61；95%置信区间（CI）0.37 - 1.01；P = 0.05]、ICU住院时长[平均差（MD），-1.24；95% CI -3.54至1.05，P = 0.29]和SOFA评分（MD，-0.85，95% CI -2.38至0.67，P = 0.27）方面无显著差异。然而，维生素C显著缩短了血管升压药的使用时长（MD，-14.36，95% CI -26.11至-2.61，P = 0.02）。此外，亚组分析发现，在发展中国家，维生素C与短期死亡率显著降低相关（OR，0.33；95% CI 0.12 - 0.90；P = 0.03）、血管升压药使用时长缩短（MD，-24.37，95% CI -33.72至-15.02，P < 0.001）以及SOFA评分降低（MD，-2.55，95% CI -4.81至-0.28，P = 0.03）。
结论
在我们的研究中，脓毒症患者使用维生素C与短期死亡率、ICU住院时长或SOFA评分的显著降低无关。然而，我们观察到维生素C可以缩短血管升压药的使用时长。此外，发展中国家的脓毒症患者可能比发达国家的患者从维生素C治疗中获益更多。标识符CRD42022380958，https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=380958 。
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