Efficacy of vitamin C in patients with sepsis: An updated meta-analysis
Introduction
Sepsis is a life-threatening critical disease triggered by a dysregulated immuno-inflammatory response to an infection (Hotchkiss et al., 2016; Singer et al., 2016). It is a major health care problem affecting 31.5 million people globally each year, including 19.4 million people with severe sepsis (Fleischmann et al., 2016). In spite of earlier diagnosis and improvement in management, sepsis was still associated with high mortality. Data from high-income countries indicated that the number of sepsis-related deaths was 2.8 million per year (Cecconi et al., 2018). In addition, patients with sepsis suffer from numerous other complications, reducing their quality of life (Yende et al., 2016; Ou et al., 2016). Given the great danger of sepsis, more effective therapeutic approaches were required.
A significant low vitamin C level was common in patients with sepsis (Belsky et al., 2018). Vitamin C, also known as ascorbic acid, is an important antioxidant that participates in several kinds of biosynthetic and metabolic processes in the human body (Marik, 2018a, Marik, 2018b). Supplementation of exogenous vitamin C might be a potential treatment for sepsis. In animal studies, the infusion of vitamin C reduced organ injury and prevented the deleterious consequences in a septic condition (Gao et al., 2017; Fisher et al., 2014). Therefore, a large number of clinical studies were performed to investigate the therapeutic effect of vitamin C in patients with sepsis. A meta-analysis conducted by Li (2018) demonstrated that the use of vitamin C could significantly reduce the mortality caused by sepsis. However, these results could not be reproduced in the subsequent studies (Mitchell et al., 2019; Ahn et al., 2019; Litwak et al., 2019; Shin et al., 2019). Thus, the role of vitamin C in patients with sepsis remains controversial. Due to the contrasting results, this updated meta-analysis, including newly published studies, was performed to further assess the value of vitamin C in patients with sepsis.
Section snippets
Search strategy and study selection
The PubMed, Web of Science, ClinicalTrials.gov , and Cochrane Library databases were searched from inception to August 2019 for relevant studies. The following search terms were used: (vitamin C or ascorbic acid) and (sepsis or septic). Also, the reference lists in the included studies and previous relevant meta-analyses were reviewed. The language was restricted to English.
The studies comparing the effect of vitamin C versus non-vitamin C infusion in patients with sepsis were included. The
Study characteristics
The flow diagram of screening strategy for inclusion in the meta-analysis is displayed in Fig. 1. A total of 946 references were identified according to the search strategy: PubMed (n = 281), Web of Science (n = 531), ClinicalTrials.gov (n = 20), and Cochrane Library (n = 114). Among these, 188 were excluded because they were duplicate studies and 657 were excluded because they did not associate with the research topic, after reviewing their titles and abstracts. The remaining 102 studies were
Discussion
The present systematic review and meta-analysis of the currently available published data reassessed the impact of vitamin C on patients with sepsis. The infusion of vitamin C did not have any beneficial effect on mortality in patients with sepsis. In addition, the use of vitamin C did not reduce the length of ICU or hospital stay and the duration of vasopressor administration. The incidence of AKI and renal replacement therapy for AKI did not increase in patients treated with vitamin C.
Sepsis
Funding
This study was supported by Medical science and Technology Research Funding of Guangdong (grant no. A2019409), the Fundamental Research Funds for the Central Universities (grant no. 2019MS136) and National Clinical Key Specialty Construction Project of China (2012-649, 2013-544). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Authors' contributions
Tie-he Qin and Shou-hong Wang conceived and designed the study. Xiao-long Liao, Wei-xin Guo and Jian-Yi Wen performed abstract screening and data extraction. Xue-biao Wei and Zhong-hua Wang analyzed the data and drafted the manuscript. All authors revised and approved the final manuscript.
Declaration of competing interest
There were no competing interests among authors.
Acknowledgements
None.
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