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Observational Study
. 2024 Feb 1;25(2):171-176.
doi: 10.1097/PCC.0000000000003349. Epub 2024 Jan 19.

Serum Levels of Vitamin C and Thiamin in Children With Suspected Sepsis: A Prospective Observational Cohort Study

Brett McWhinney  1 , Jacobus Ungerer  1 , Renate LeMarsey  2   3 , Natalie Phillips  2   3   4 , Sainath Raman  2   3 , Kristen Gibbons  2   3 , Luregn J Schlapbach  2   3   5   6 ; Rapid Acute Paediatric Infection Diagnosis in Suspected Sepsis (RAPIDS) Study Investigators
Collaborators, Affiliations
Observational Study

Serum Levels of Vitamin C and Thiamin in Children With Suspected Sepsis: A Prospective Observational Cohort Study

Brett McWhinney et al. Pediatr Crit Care Med. .

Abstract

Objectives: Vitamin C and thiamin have been trialed as adjunctive therapies in adults with septic shock but their role in critically ill children is unclear. We assessed serum levels of vitamin C and thiamin in children evaluated for sepsis.

Design: Single-center prospective observational study. Serum levels of vitamin C and thiamin were measured on admission and association with multiple organ dysfunction syndrome (MODS) was explored using logistic regression.

Setting: Emergency department and PICU in a tertiary children's hospital, Queensland, Australia.

Patients: Children greater than 1 month and less than 17 years evaluated for sepsis.

Interventions: Not applicable.

Measurements and main results: Vitamin levels were determined in 221 children with a median age of 3.5 (interquartile range [IQR] 1.6, 8.3) years. Vitamin C levels were inversely correlated with severity as measured by pediatric Sequential Organ Failure Assessment (Spearman's rho = -0.16, p = 0.018). Median (IQR) vitamin C levels on admission were 35.7 (17.9, 54.1) µmol/L, 36.1 (21.4, 53.7) µmol/L, and 17.9 (6.6, 43.0) µmol/L in children without organ dysfunction, single organ dysfunction, and MODS, respectively (p = 0.017). In multivariable analyses, low levels of vitamin C at the time of sampling were associated with greater odds of MODS (adjusted odds ratio [aOR] 3.04; 95% CI, 1.51-6.12), and vitamin C deficiency was associated with greater odds of MODS at 24 hours after sampling (aOR 3.38; 95% CI, 1.53-7.47). Median (IQR) thiamin levels were 162 (138, 192) nmol/L, 185 (143, 200) nmol/L, and 136 (110, 179) nmol/L in children without organ dysfunction, single organ dysfunction, and MODS, respectively (p = 0.061). We failed to identify an association between thiamin deficiency and either MODS at sampling (OR 2.52; 95% CI, 0.15-40.86) or MODS at 24 hours (OR 2.96; 95% CI, 0.18-48.18).

Conclusions: Critically ill children evaluated for sepsis frequently manifest decreased levels of vitamin C, with lower levels associated with higher severity.

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Conflict of interest statement

Dr. Schlapbach received support for article research from the Australian Government’s Medical Research Future Fund Rapid Applied Research Translation program grant awarded to Brisbane Diamantina Health Partners; he received funding from a National Health and Medical Research Council Practitioner Fellowship and the Children’s Hospital Foundation, Australia. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Serum levels of vitamin C (A, C) and thiamin (B, D) are shown for n = 221 children evaluated for sepsis in relation to the degree of organ dysfunction at the time of blood sampling (A, B: no organ dysfunction, n = 139; single organ dysfunction, n = 19, multiple organ dysfunction, n = 63), and in relation to the pediatric Sequential Organ Failure Assessment score (pSOFA, C, D). Box-whisker plots indicate the median and interquartile range. The dashed horizontal lines indicate the threshold to define vitamin C deficiency (< 11 µmol/L), and thiamin deficiency (< 70 nmol/L), respectively. pSOFA = pediatric Sequential Organ Failure Assessment.
See this image and copyright information in PMC

References

    1. Schlapbach LJ, Straney L, Alexander J, et al. ; ANZICS Paediatric Study Group: Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: A multicentre retrospective cohort study. Lancet Infect Dis. 2015; 15:46–54 - PubMed
    1. Weiss SL, Peters MJ, Alhazzani W, et al. : Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020; 46:10–67 - PMC - PubMed
    1. Schlapbach LJ, MacLaren G, Festa M, et al. ; Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE) and Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group: New Zealand Intensive Care Society Paediatric Study: Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive Care Med. 2017; 43:1085–1096 - PubMed
    1. Mehta NM: Resuscitation with vitamins C and B1 in pediatric sepsis—hold on to your “HAT.”. Pediatr Crit Care Med. 2022; 23:385–389 - PubMed
    1. Wilson JX: Mechanism of action of vitamin C in sepsis: Ascorbate modulates redox signaling in endothelium. Biofactors. 2009; 35:5–13 - PMC - PubMed

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