Vitamin C deficiency and its effect as adjuvant therapy in sepsis patients
Abstract
Sepsis causes high mortality and organ failure; vitamin C deficiency is common and may worsen inflammation and shock, supporting its role as an adjunctive therapy. To evaluate plasma vitamin C levels in sepsis and septic shock and assess the effects of high-dose intravenous vitamin C on inflammation, hemodynamics, organ dysfunction, and clinical outcomes. This prospective, interventional, non-randomized controlled cohort study was conducted in the 25-bed Critical Care Department of Cairo University Hospitals between December 2019 and September 2021. One hundred adult ICU patients with sepsis or septic shock were enrolled after ethical approval and informed consent. Patients with sepsis or septic shock were enrolled according to the Sepsis-3 consensus definitions and Surviving Sepsis Campaign recommendations. SIRS variables were recorded as baseline inflammatory parameters. Patients received either intravenous vitamin C (6 g/day for 4 days; n = 75) or placebo (n = 25). Plasma vitamin C levels were measured at baseline and day 4. Outcomes included inflammatory markers, hemodynamics, organ support, SOFA scores, ICU stay, and mortality. Baseline characteristics were similar: age 61 ± 15 years, males 49%, APACHE II 21 ± 5 vs. 19 ± 5 (p = 0.37), SOFA day-0 9.6 ± 4.5 vs. 10.1 ± 4.0 (p = 0.526). By day-4 and day-6, SOFA was lower with vitamin C (5.5 ± 3.1 vs. 9.2 ± 4.2, p = 0.049; 3.3 ± 2.5 vs. 8.1 ± 4.1, p = 0.002). Vitamin C levels increased by day-4 (> 70 µmol/L: 50.7% vs. 8.0%, p < 0.001). CRP declined from day-1 to day-4 (all p < 0.001). Vasopressor dose was lower on day-1 (p = 0.026) and day-4 (p = 0.05). MAP, TLC, MV, RRT, ICU stay, and mortality showed no intergroup differences. Greatest benefit occurred in vitamin C–deficient patients. High-dose intravenous vitamin C (6 g/day for 4 days) safely corrected vitamin C deficiency and improved inflammation, SOFA score, and vasopressor requirements, particularly in vitamin C-deficient patients, without reducing ICU stay or mortality.