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Review
. 2023 Aug 31:10:1244484.
doi: 10.3389/fmed.2023.1244484. eCollection 2023.

The effect of vitamin C in adults with sepsis: a meta-analysis of randomized controlled trials

Xing Luo  1 , Youfeng Zhu  1 , Rui Zhang  1 , JianQiu Zhu  1 , Huanming Kuang  1 , Yuebin Shao  2 , Xinmin Guo  3 , Bo Ning  4
Affiliations
Review

The effect of vitamin C in adults with sepsis: a meta-analysis of randomized controlled trials

Xing Luo et al. Front Med (Lausanne). .

Abstract

Background: The effect of intravenous (IV) vitamin C in the treatment of sepsis remains controversial. We aimed to explore the clinical efficacy of vitamin C in the treatment of sepsis.

Methods: Electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched from inception through November 15th, 2022, for randomized controlled trials evaluating the effect of IV vitamin C treatment in patients with sepsis. The primary outcome was short-term mortality, secondary outcomes included duration of vasopressor use, length of intensive care unit (ICU) stay, and Sequential Organ Failure Assessment (SOFA) score after vitamin C treatment. Subgroup analyses were performed based on the dose and duration of IV vitamin C and region to determine whether vitamin C benefited patients with sepsis.

Results: A total of 10 studies including 1,426 patients fulfilled the predefined criteria and were analyzed. Overall, there were no significant differences between the vitamin C group and the control group regarding short-term mortality [odds ratio (OR), 0.61; 95% confidence interval (CI) 0.37-1.01; p = 0.05], ICU length of stay [mean difference (MD), -1.24; 95% CI -3.54 to 1.05, p = 0.29] and SOFA score (MD, -0.85, 95% CI -2.38 to 0.67, p = 0.27). However, vitamin C significantly reduced the duration of vasopressor use (MD, -14.36, 95% CI -26.11 to -2.61, p = 0.02). Furthermore, subgroup analysis found that in developing countries, vitamin C was associated with a significant reduction in short-term mortality (OR, 0.33; 95% CI 0.12-0.90; p = 0.03), duration of vasopressor use (MD, -24.37, 95% CI -33.72 to -15.02, p < 0.001) and SOFA score (MD, -2.55, 95% CI -4.81 to -0.28, p = 0.03).

Conclusion: In our study, vitamin C administration for sepsis patients was not associated with a significant reduction in short-term mortality, length of ICU stay or SOFA score. However, we observed that vitamin C could reduce the duration of vasopressor use. Furthermore, sepsis patients in developing countries may benefit more from vitamin C administration than those in developed countries.Systematic review registration: Identifier CRD42022380958, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=380958.

Keywords: meta-analysis; mortality; sepsis; treatment; vitamin C.

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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
PRISMA flow diagram showing search and selection study selection strategies.
Figure 2
Figure 2
Risk of bias assessment.
Figure 3
Figure 3
Meta-analysis of short-term mortality in patients receiving vitamin C therapy versus placebo.
Figure 4
Figure 4
Comparison of vitamin C versus placebo with regards to duration of vasopressor use (A), Length of ICU stay (B) and SOFA score (C).
Figure 5
Figure 5
Comparison of CRP level between vitamin C group and placebo group. CRP: C-reactive protein.
See this image and copyright information in PMC

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