by Sander Rozemeijer, Frans A. L. van der Horst and
Angélique M. E. de Man
Critical Care volume 25,
Article number: 310 (2021) Published: 31
August 2021
Interest in intravenous vitamin C administration has rapidly
increased in the field of critical care medicine over recent years. The first
studies investigating the effect of intravenous vitamin C in septic (shock)
patients showed a decrease in organ dysfunction, vasopressor dependency, and
even a reduction in mortality [1,2,3].
Within a short period of time, multiple trials in septic patients were
conducted to confirm these promising findings, but results were not uniform [4,5,6,7,8,9,10,11,12].
The inconsistencies in effects on outcome may partially be explained by
differences in study design [8],
in particular the dosing regimens (timing, duration and dose) and choice of
co-medication. For example, vitamin C administration has been investigated
alone, or in combination with thiamine and/or hydrocortisone, sometimes with
uncontrolled use of hydrocortisone in the control group. There is also
considerable variety among septic patients as sepsis is a heterogeneous
syndrome. Therefore, some subgroups of patients might benefit more than others
from intravenous vitamin C therapy. A recently published meta-analysis on
mortality performed subgroup analyses and found a beneficial effect of vitamin
C on short-term mortality (< 30 days). Additionally, survival was
improved by a treatment duration of 3–4 days [13].
The results of vitamin C alone versus combination therapy were not different. A
particular subgroup of interest is patients with vitamin C deficiency. None of
the studies performed subgroup analyses on vitamin C deficient patients. This
is unfortunate, but understandable, since the measurement of plasma vitamin C
concentration is difficult.
In this chapter, we discuss the practical problems and
pitfalls of measuring vitamin C and describe a novel potential surrogate marker
that can estimate vitamin C status.
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