Objectives: The effects of vitamin C administration on clinical outcome in
critically ill patients remain controversial.
Data Sources: Online databases were searched up to October
1, 2018.
Study Selection: We included randomized controlled trials on
the use of vitamin C (any regimen) in adult critically ill patients versus
placebo or no therapy.
Data Extraction: Risk ratio for dichotomous outcome and standardized
mean difference for continuous outcome with 95% CI were calculated using
random-effects model meta-analysis.
Data Synthesis: Forty-four randomized studies, 16 performed
in ICU setting (2,857 patients) and 28 in cardiac surgery (3,598 patients),
published between 1995 and 2018, were included in the analysis. In ICU
patients, vitamin C administration was not associated with a difference in
mortality (risk ratio, 0.90; 95% CI, 0.74–1.10; p = 0.31), acute kidney injury,
ICU or hospital length of stay compared with control. In cardiac surgery,
vitamin C was associated to a reduction in postoperative atrial fibrillation
(risk ratio, 0.64; 95% CI, 0.52–0.78; p < 0.0001), ICU stay (standardized
mean difference, –0.28 d; 95% CI, –0.43 to –0.13 d; p = 0.0003), and hospital
stay (standardized mean difference, –0.30 d; 95% CI, –0.49 to –0.10 d; p =
0.002). Furthermore, no differences in postoperative mortality, acute kidney
injury, stroke, and ventricular arrhythmia were found.
Conclusions: In a mixed population of ICU patients,
vitamin C administration is associated with no significant effect on survival,
length of ICU or hospital stay. In cardiac surgery, beneficial effects on
postoperative atrial fibrillation, ICU or hospital length of stay remain
unclear. However, the quality and quantity of evidence is still insufficient to
draw firm conclusions, not supporting neither discouraging the systematic
administration of vitamin C in these populations. Vitamin C remains an
attractive intervention for future investigations aimed to improve clinical
outcome.
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