scholarly journals Vitamin C in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3564
Author(s):  
Dhan Bahadur Shrestha ◽  
Pravash Budhathoki ◽  
Yub Raj Sedhai ◽  
Sujit Kumar Mandal ◽  
Shreeja Shikhrakar ◽  
...  
Keyword(s):  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Water Soluble ◽  
Icu Stay ◽  
Significant Difference ◽  
Intravenous Vitamin

Background: Vitamin C is a water-soluble antioxidant vitamin. Oxidative stress and its markers, along with inflammatory markers, are high during critical illness. Due to conflicting results of the published literature regarding the efficacy of vitamin C in critically ill patients, and especially the concerns for nephrotoxicity raised by some case reports, this meta-analysis was carried out to appraise the evidence and affirmation regarding the role of vitamin C in critically ill patients. Methods: We searched the database thoroughly to collect relevant studies that assessed intravenous vitamin C use in critically ill patients published until 25 February 2021. We included randomized controlled trials and observational studies with 20 or more critically ill patients who have received intravenous ascorbic acid (vitamin C). After screening 18,312 studies from different databases, 53 were included in our narrative synthesis, and 48 were included in the meta-analysis. We used the Covidence software for screening of the retrieved literature. Review Manager (RevMan) 5.4 was used for the pooling of data and Odds Ratios (OR) and Mean difference (MD) as measures of effects with a 95% confidence interval to assess for explanatory variables. Results: Pooling data from 33 studies for overall hospital mortality outcomes using a random-effect model showed a 19% reduction in odds of mortality among the vitamin C group (OR, 0.81; 95% CI, 0.66–0.98). Length of hospital stay (LOS), mortality at 28/30 days, ICU mortality, new-onset AKI and Renal Replacement Therapy (RRT) for AKI did not differ significantly across the two groups. Analysis of data from 30 studies reporting ICU stay disclosed 0.76 fewer ICU days in the vitamin C group than the placebo/standard of care (SOC) group (95% CI, −1.34 to −0.19). This significance for shortening ICU stay persisted even when considering RCTs only in the analysis (MD, −0.70; 95% CI, −1.39 to −0.02). Conclusion: Treatment of critically ill patients with intravenous vitamin C was relatively safe with no significant difference in adverse renal events and decreased in-hospital mortality. The use of vitamin C showed a significant reduction in the length of ICU stays in critically ill patients.

scholarly journals Safety of High-Dose Vitamin C in Critically Ill Patients: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Dhan Bahadur Shrestha ◽  
Pravash Budhathoki ◽  
Yub Raj Sedhai ◽  
Sujit Kumar Mandal ◽  
Shreeja Shikhrakar ◽  
...  
Keyword(s):  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Case Series ◽  
High Dose ◽  
Slight Reduction ◽  
Pooled Data

Abstract Objective:High-Dose Intravenous Vitamin C (HDIVC) is currently a controversial therapy for sepsis and ARDS. The published evidence regarding its efficacy in critically ill patients has shown conflicting results, and in fact, case reports have raised concerns for nephrotoxicity. The objective of this meta-analysis is to critically appraise the latest evidence regarding the safety of HDIVC in critically ill patients.Data Sources: Structured literature search on PubMed, PubMed Central, Scopus, Embase, and Google Scholar.Study Selection: Cross-sectional studies, case-control studies, cohort studies, randomized controlled trials, and case series with 20 or more critically ill patients who have received intravenous ascorbic acid (vitamin C), published till February 25, 2021. We identified 53 studies in our qualitative analysis and 48 studies in our quantitative analysis among a standardized search of 18,312 studies.Data Synthesis:We pooled data and calculated Odds Ratios (OR) and Mean Differences (MD) with their 95% confidence intervals to assess explanatory variables. Based on a random effect model from 33 studies, pooled hospital mortality outcomes showed a 19% reduction in odds for overall hospital mortality among the HDIVC group (OR, 0.81; 95% CI, 0.66-0.98). Mortality at 28/30-days, ICU mortality, length of hospital stay (LOS), new-onset AKI, and Renal Replacement Therapy (RRT) for AKI did not differ significantly across treatment and control groups. Pooled data from 30 studies disclosed 0.76 fewer ICU days in the HDIVC group than the placebo/ standard of care (SOC) group, 95% CI, -1.34 to -0.19. This significance persisted when we included RCTs only in the analysis (MD, -0.70; 95% CI, -1.39 to -0.02).Conclusions:Our results suggest that HDIVC treatment is renally safe and did not increase adverse kidney events, or mortality. It was associated with a slight reduction in ICU length of stay in critically ill patients.

scholarly journals Use of Intravenous Vitamin C in Critically Ill Patients With COVID-19 Infection

2021 ◽  
pp. 089719002110150
Author(s):  
Matthew Li ◽  
Tsung Han Ching ◽  
Christopher Hipple ◽  
Ricardo Lopez ◽  
Asad Sahibzada ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Objective ◽  
Primary Study ◽  
Protective Effects ◽  
Icu Length Of Stay ◽  
Intravenous Vitamin

Introduction The pathophysiology for Coronavirus Disease 2019 (COVID-19) infection is characterized by cytokine oxidative stress and endothelial dysfunction. Intravenous (IV) vitamin C has been utilized as adjuvant therapy in critically ill patients with sepsis for its protective effects against reactive oxygen species and immunomodulatory effects. The primary objective of this study was to evaluate the effects of IV vitamin C in critically ill patients with COVID-19 infection. Methods Retrospective observational cohort study with propensity score matching of intensive care unit (ICU) patients who received 1.5 grams IV vitamin C every 6 hours for up to 4 days for COVID-19 infection. The primary study outcome was in-hospital mortality. Secondary outcomes included vasopressor requirements in norepinephrine equivalents, ICU length of stay, and change in Sequential Organ Failure Assessment (SOFA) score. Results Eight patients received IV vitamin C and were matched to 24 patients. Patients in the IV vitamin C group had higher rates of hospital mortality [7 (88%) vs. 19 (79%), P = 0.049]. There was no difference in the daily vasopressor requirement in the treatment group or between the 2 groups. The mean SOFA scores post-treatment was higher in the IV vitamin C group (12.4 ± 2.8 vs. 8.1 ± 3.5, P < 0.005). There was no difference in ICU length of stay between the treatment and control groups. Conclusion Adjunctive IV vitamin C for the management of COVID-19 infection in critically ill patients may not decrease the incidence of mortality, vasopressor requirements, SOFA scores, or ventilator settings.

scholarly journals The Role of Mean Platelet Volume as a Predictor of Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Pattraporn Tajarernmuang ◽  
Arintaya Phrommintikul ◽  
Atikun Limsukon ◽  
Chaicharn Pothirat ◽  
Kaweesak Chittawatanarat
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mean Platelet Volume ◽  
Meta Analysis ◽  
Small Sample ◽  
Mean Difference ◽  
Platelet Volume ◽  
Significant Difference ◽  
The Mean

Background. An increase in the mean platelet volume (MPV) has been proposed as a novel prognostic indicator in critically ill patients.Objective. We conducted a systematic review and meta-analysis to determine whether there is an association between MPV and mortality in critically ill patients.Methods. We did electronic search in Medline, Scopus, and Embase up to November 2015.Results. Eleven observational studies, involving 3724 patients, were included. The values of initial MPV in nonsurvivors and survivors were not different, with the mean difference with 95% confident interval (95% CI) being 0.17 (95% CI: −0.04, 0.38;p=0.112). However, after small sample studies were excluded in sensitivity analysis, the pooling mean difference of MPV was 0.32 (95% CI: 0.04, 0.60;p=0.03). In addition, the MPV was observed to be significantly higher in nonsurvivor groups after the third day of admission. On the subgroup analysis, although patient types (sepsis or mixed ICU) and study type (prospective or retrospective study) did not show any significant difference between groups, the difference of MPV was significantly difference on the unit which had mortality up to 30%.Conclusions. Initial values of MPV might not be used as a prognostic marker of mortality in critically ill patients. Subsequent values of MPV after the 3rd day and the lower mortality rate unit might be useful. However, the heterogeneity between studies is high.

scholarly journals P052 Should measurement of ascorbic acid become routine in the management of patients on home parenteral nutrition?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.58-e2
Author(s):  
Amy-Jo Hooley ◽  
Brandy Cox ◽  
David Devadason ◽  
James Hunter
Keyword(s):  
Ascorbic Acid ◽  
Vitamin C ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Micronutrient Deficiency ◽  
Water Soluble ◽  
List Type ◽  
Vitamin C Deficiency

AimTo assess if routine monitoring of vitamin C in long term parenteral nutrition (PN) patients should be routinely carried out, following a case report of a child with clinical vitamin C deficiency.MethodsVitamin C is an essential water soluble nutrient that cannot be synthesised or stored by humans.1 It is a potent antioxidant with anti-inflammatory and immune- supportive roles,1 Vitamin C levels are depleted in critically ill patients, those with restricted diets, smokers, and those with severe digestive disorders. The stability of micronutrients in PN bags is assumed but rarely confirmed, although a decrease in vitamin C content has been observed when there is a long delay between preparation and packaging.2 The patient, a five year old child stable on long term established full PN presented with a one month gradual reduction in mobility, refusal to weight bear, intermittent temperatures, raised CRP and asymptomatic hypercalcaemia on routine bloods. Investigations included bone profile, vitamin D, and parathyroid hormone levels, and routine sepsis screening. Following the extensive work up for systemic disorders and multiple conversations with orthopaedic and radiology specialists, it was discovered that the patient had bilateral metaphyseal irregularities, which were felt to be in keeping with recognised radiological appearances seen in severe vitamin C deficiency. As a result of this her PN bags were made manufactured and analysed in house quality control laboratory using a method involving UV –vis spectrophotometer to analyse the rate of oxidative decomposition of vitamin C within the bags.ResultsIn the United Kingdom children on long term PN programmes are routinely monitored for selected micronutrient deficiency, but not routinely vitamin C. The vitamin C was increased in the PN to three times the baseline dose for this patient, and a dramatic improvement in the patients symptoms were observed within 5 days, and radiological improvement was noted within 6 weeks after commencing treatment. Unfortunately baseline vitamin C levels were not obtained prior to starting treatment, but levels one month later still showed a significant clinical deficiency. The test bags that were analysed within the laboratory showed that on manufacture the bags contained 48.34 mg/L of ascorbic acid, but by 48 hours this had decreased to 8.5 mg/L.ConclusionVitamin C in PN is at significant risk of degradation by oxidation. Awareness of signs and symptoms of micronutrient deficiency and vigilance of micronutrient deficiencies not routinely measured in children on parenteral nutrition is important. Also more research is required into the oxidation rate of vitamin C in PN to establish how much is required within the PN bag to ensure the recommended daily intake in a PN dependent patient.ReferencesCarr AC, Rosengrave PC, Bayer S, Chambers S, Mehrtens J, Shaw GM. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Crit Care. 2017;21(1):300. Published 2017 December 11. doi:10.1186/s13054-017-1891-yConroy S, Alsenani A, Sammons H. Factors influencing reported rate of paediatric medication errors. Archives of Disease in Childhood 2014;99:e3. https://adc.bmj.com/content/99/8/e3.19

scholarly journals Clinical Effect of Intravenous Vitamin C on Viral Myocarditis in Children: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Shuangdi Chen ◽  
Wenli Zhao ◽  
Binjie Zhang ◽  
Yijun Jia ◽  
Shihua Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vitamin C ◽  
Conventional Therapy ◽  
Total Effective Rate ◽  
Meta Analysis ◽  
Viral Myocarditis ◽  
Effective Rate ◽  
Cochrane Library ◽  
Significant Difference ◽  
Intravenous Vitamin

Objective. To comprehensively compare the effects of conventional therapy combined with intravenous vitamin C and conventional therapy on viral myocarditis in children through a meta-analysis. Methods. Relevant articles including clinical trials of normal treatment combined with intravenous vitamin C and conventional therapy for viral myocarditis in children that were published between January 2000 and February 2018 were selected from PubMed, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and WANFANG database. The quality of the included studies was assessed using the Cochrane systematic review method (version 5.1.0); data quality was evaluated by two independent researchers. The total effective rate; LDH, CK, and CK-MB levels; and other indicators were analyzed using Rev Man 5.3 software. Results. Eight studies were eligible for this meta-analysis, which included a total of 426 patients in the treatment group and 363 patients in the control group. The meta-analysis results of six studies showed that the total effective rate of intravenous vitamin C combined with conventional therapy was higher than that of conventional therapy alone [Z = 5.46, 95% confidence interval (CI): 1.21 (1.13 to 1.30), P < 0.00001]; that of five studies showed that LDH levels were lower in children receiving intravenous vitamin C combined with conventional therapy than in those receiving conventional therapy alone [Z = 3.70, 95% CI: −1.88 (−2.88 to −0.88), P = 0.0002]; that of three studies showed that CK levels were lower in children receiving intravenous vitamin C combined with conventional therapy than in those receiving conventional therapy alone [Z = 4.21, 95% CI: −0.55 (−0.81 to −0.30), P < 0.0001]; that of four studies showed that CK-MB levels were lower in children receiving intravenous vitamin C combined with conventional therapy than in those receiving conventional therapy alone [Z = 13.64, 95% CI: −1.44 (−1.65 to −1.24), P < 0.00001]; that of two studies showed that CD3 levels were higher in children receiving intravenous vitamin C combined with conventional therapy than in those receiving conventional therapy alone [Z = 2.45, 95% CI: 0.41 (0.08–0.73), P = 0.01]; that of two studies showed no significant difference in changes in CD4 levels between children receiving intravenous vitamin C combined with conventional therapy and those receiving conventional therapy alone [Z = 0.28, 95% CI: −0.21 (−1.69 to 1.28), P = 0.78]; and that of two studies showed no significant difference in changes in CD4/CD8 between children receiving intravenous vitamin C combined with conventional therapy and those receiving conventional therapy alone [Z = 0.07, 95% CI: −0.03 (−0.73 to 0.67), P = 0.94]. Conclusion. The meta-analysis results showed that intravenous vitamin C combined with conventional therapy is better than the simple, conventional therapy for the treatment of viral myocarditis in children in terms of the total effective rate and LDH, CK, and CK-MB levels.

scholarly journals High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e014171 ◽  
Author(s):  
Peng Li ◽  
Li-ping Qu ◽  
Dong Qi ◽  
Bo Shen ◽  
Yi-mei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

scholarly journals Evaluation of zinc sulfate as an adjunctive therapy in COVID-19 critically ill patients: a two center propensity-score matched study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Aljuhani ◽  
Abdulrahman I. Al Shaya ◽  
Abdullah Kharbosh ◽  
Raed Kensara ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adjunctive Therapy ◽  
Zinc Sulfate ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Additional Treatment ◽  
Icu Stay

Abstract Background Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19. Methods Patients aged ≥ 18 years with COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use from March 1, 2020 until March 31, 2021. After propensity score matching (1:1 ratio) based on the selected criteria, we assessed the association of zinc used as adjunctive therapy with the 30-day mortality. Secondary outcomes included the in-hospital mortality, ventilator free days, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay. Results A total of 164 patients were included, 82 patients received zinc. Patients who received zinc sulfate as adjunctive therapy have a lower 30-day mortality (HR 0.52, CI 0.29, 0.92; p = 0.03). On the other hand, the in-hospital mortality was not statistically significant between the two groups (HR 0.64, CI 0.37–1.10; p = 0.11). Zinc sulfate use was associated with a lower odds of acute kidney injury development during ICU stay (OR 0.46 CI 0.19–1.06; p = 0.07); however, it did not reach statistical significance. Conclusion The use of zinc sulfate as an additional treatment in critically ill COVID-19 patients may improve survival. Furthermore, zinc supplementation may have a protective effect on the kidneys.

scholarly journals Association of Preadmission Statin Use and Mortality in Critically Ill Patients: A Meta-Analysis of Cohort Studies

2021 ◽  
Vol 8 ◽  
Author(s):  
Shao-shuo Yu ◽  
Jian Jin ◽  
Ren-qi Yao ◽  
Bo-li Wang ◽  
Lun-yang Hu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Newcastle Ottawa Scale ◽  
English Articles ◽  
Statin Use

Background: A large number of studies have been conducted to determine whether there is an association between preadmission statin use and improvement in outcomes following critical illness, but the conclusions are quite inconsistent. Therefore, this meta-analysis aims to include the present relevant PSM researches to examine the association of preadmission use of statins with the mortality of critically ill patients.Methods: The PubMed, Web of Science, Embase electronic databases, and printed resources were searched for English articles published before March 6, 2020 on the association between preadmission statin use and mortality in critically ill patients. The included articles were analyzed in RevMan 5.3. The Newcastle-Ottawa Scale (NOS) was used to conduct quality evaluation, and random/fixed effects modeling was used to calculate the pooled ORs and 95% CIs. We also conducted subgroup analysis by outcome indicators (30-, 90-day, hospital mortality).Results: All six PSM observational studies were assessed as having a low risk of bias according to the NOS. For primary outcome—overall mortality, the pooled OR (preadmission statins use vs. no use) across the six included studies was 0.86 (95% CI, 0.76–0.97; P = 0.02). For secondary outcome—use of mechanical ventilation, the pooled OR was 0.94 (95% CI, 0.91–0.97; P = 0.0005). The corresponding pooled ORs were 0.67 (95% CI, 0.43–1.05; P = 0.08), 0.91 (95% CI, 0.83–1.01; P = 0.07), and 0.86 (95% CI, 0.83–0.89; P &lt; 0.00001) for 30-, 90-day, and hospital mortality, respectively.Conclusions: Preadmission statin use is associated with beneficial outcomes in critical ill patients, indicating a lower short-term mortality, less use of mechanical ventilation, and an improvement in hospital survival. Further high-quality original studies or more scientific methods are needed to draw a definitive conclusion.

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