/ Kwangmoo, stockadobecom
Quebec / Canada – The hope of improving the prognosis of patients with life-threatening sepsis through the administration of high doses of vitamin C was not met in a randomized study. According to a publication in New England Journal of Medicine (2022; DOI: 10.1056 / NEJMoa2200644), organ failure or patient death was even more common.
Sepsis is the most serious complication of an infectious disease and a leading cause of death in hospitals. It is the result of an overwhelmed immune system that is no longer able to control pathogens. The violent immune reaction can end up doing more harm than good to the body. Vitamin C treatment is based on the observation that the immune system needs higher amounts of the vitamin. Eventually, this may no longer be available in sufficient quantities. This is supported by the low serum concentrations of many critically ill patients.
In recent years, studies have repeatedly attempted to improve the situation of patients with the inexpensive vitamin, which is also classified as harmless in larger quantities. However, no convincing results have been achieved.
An initiative by Canadian ICU doctors has now also failed. For the Lessening Organ Dysfunction With VITAmin C (LOVIT) study, the Canadian Critical Care Trials Group included 872 patients who had been in ICU for sepsis for less than 1 day and who already needed circulatory support randomized vasopressors to vitamin C. high dose or placebo. Infusions of 50 mg / kg of vitamin C per body weight were repeated every 6 hours (maximum up to 96 hours).
Treatment with high doses of vitamin C resulted in more deaths
The hope was to prevent organ failure and patient death. This didn’t work. As Francois Lamontagne of the Université de Sherbrooke in Quebec and colleagues report, the patient died more frequently in the first 28 days or there were persistent organ disorders. This primary study endpoint occurred in 191 of 429 patients (44.5%) in the vitamin C group compared with 167 of 434 patients (38.5%) in the control group. The hazard ratio of 1.21 was even significant with a 95% confidence interval between 1.04 and 1.40. The disadvantage was mainly due to patients with persistent organ dysfunction (9.1% vs 6.9%; hazard ratio 1.30; 0.83-2.05). The risk of death (35.4% versus 31.6%; hazard ratio 1.17; 0.98-1.40) also tended to be higher.
Doctors have not been able to determine the reason for the damaging effects of high-dose vitamin C treatment. There were no differences between the groups in biomarkers for tissue deoxia (lactate), inflammation (interleukin 1beta, tumor necrosis factor-alpha), or endothelial damage (thrombomodulin, angiopoietin-2). The only abnormality was a tendency to increase hypoglycemia (6.1% vs 5.1%; hazard ratio 1.25; 0.73-2.14) and an anaphylactic reaction in the vitamin C group.
Further insights into the efficacy and safety of high-dose vitamin C treatment in ICU patients are awaited from the REMAP-CAP study and the LOVIT-COVID study in COVID-19 patients. A French study examines the effects of acute pulmonary failure. © rme / aerzteblatt.de