Vitamin C doesnot improve outcomes in sepsis and ARDS patients: JAMA

USA: Experimental data suggests that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS). Defying this, a recent study published in the JAMA journal has found no significant role of vitamin C in improving outcomes related to inflammation, vascular injury, or organ failure in patients with acute respiratory distress syndrome (ARDS) and sepsis.

According to WHO, sepsis arises when the body's response to an infection injures its own tissues and organs, potentially leading to death or significant morbidity.

Acute respiratory distress syndrome occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in the lungs, according to Mayo Clinic. The fluid keeps the lungs from filling with enough air, resulting in less oxygen reaching the bloodstream. This deprives organs of the oxygen they need to function. It typically occurs in people who are already critically ill or who have significant injuries.

Alpha A. Fowler III, Virginia Commonwealth University, Richmond, and colleagues determined the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS. For the purpose, the researchers designed the CITRIS-ALI trial -- a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018.

Patients were randomly assigned to receive an intravenous infusion of vitamin C (50 mg/kg in dextrose 5% in water, n = 84) or placebo (dextrose 5% in water only, n = 83) every 6 hours for 96 hours. The primary outcomes were a change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours.

Also Read: Vitamin C in ICU patients- Controversial benefits with lagging evidence

Key findings of the study include:

• Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60.


• There were no significant differences between the vitamin C and placebo groups in the primary endpoints of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; or in C-reactive protein levels (54.1 vs 46.1 μg/mL) and thrombomodulin levels (14.5 vs 13.8 ng/mL) at 168 hours.

Also Read: Vitamin C does not significantly improve outcomes of ICU patients

"In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS," concluded the authors.