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. 2022 Feb 11:9:814587.
doi: 10.3389/fmed.2022.814587. eCollection 2022.

Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis

Evdokia Gavrielatou  1 , Eleni Xourgia  1 , Nikoleta A Xixi  1 , Athina G Mantelou  1 , Eleni Ischaki  1 , Aggeliki Kanavou  1 , Dimitris Zervakis  1 , Christina Routsi  1 , Anastasia Kotanidou  1 , Ilias I Siempos  1   2
Affiliations

Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis

Evdokia Gavrielatou et al. Front Med (Lausanne). .

Abstract

Background: Whether vitamin C provides any benefit when administered in critically ill patients, including those with coronavirus disease (COVID-19), is controversial. We endeavored to estimate the effect of administration of vitamin C on clinical outcomes of critically ill patients with COVID-19 by performing an observational study and subsequent meta-analysis.

Methods: Firstly, we conducted an observational study of critically ill patients with laboratory-confirmed COVID-19 who consecutively underwent invasive mechanical ventilation in an academic intensive care unit (ICU) during the second pandemic wave. We compared all-cause mortality of patients receiving vitamin C ("vitamin C" group) or not ("control" group) on top of standard-of-care. Subsequently, we systematically searched PubMed and CENTRAL for relevant studies, which reported on all-cause mortality (primary outcome) and/or morbidity of critically ill patients with COVID-19 receiving vitamin C or not treatment. Pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO.

Results: In the observational study, baseline characteristics were comparable between the two groups. Mortality was 20.0% (2/10) in the vitamin C group vs. 47.6% (49/103; p = 0.11) in the control group. Subsequently, the meta-analysis included 11 studies (6 observational; five randomized controlled trials) enrolling 1,807 critically ill patients with COVID-19. Mortality of patients receiving vitamin C on top of standard-of-care was not lower than patients receiving standard-of-care alone (25.8 vs. 34.7%; RR 0.85, 95% CI 0.57-1.26; p = 0.42).

Conclusions: After combining results of our observational cohort with those of relevant studies into a meta-analysis of data from 1,807 patients, we found that administration vitamin C as opposed to standard-of-care alone might not be associated with lower of mortality among critically ill patients with COVID-19. Additional evidence is anticipated from relevant large randomized controlled trials which are currently underway.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021276655.

Keywords: acute respiratory distress syndrome; acute respiratory failure; coronavirus; intensive care unit; mechanical ventilation; pneumonia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
All-cause mortality of critically ill patients with COVID-19 receiving vitamin C on top of standard-of-care (vitamin C group) vs. standard-of-care alone (control group). Pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using a random effects model.
See this image and copyright information in PMC

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