Effect of high-dose vitamin C therapy on severe burn patients: a nationwide cohort study

Abstract Background Vitamin C is a well-documented antioxidant that reduces oxidative stress and fluid infusion in high doses; however, the association between high-dose vitamin C and reduced mortality remains unclear. This study evaluates the effect of high-dose vitamin C in severe burn patients under two varying thresholds. Methods We enrolled adult patients with severe burns (burn index ≥ 15) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2016. Propensity score matching was performed between patients who received high-dose vitamin C within 1 day of admission (vitamin C group) and those who did not (control group). High-dose vitamin C was defined as a dosage in excess of 10 g or 24 g within 2 days of admission. The primary outcome was in-hospital mortality. Results Eligible patients (n = 2713) were categorized into the vitamin C group (n = 157) or control group (n = 2556). After 1:4 propensity score matching, we compared 157 and 628 patients who were administered high-dose vitamin C (> 10-g threshold) and controls, respectively. Under this particular threshold, high-dose vitamin C therapy was associated with reduced in-hospital mortality (risk ratio, 0.79; 95% confidence interval, 0.66–0.95; p = 0.006). In contrast, in-hospital mortality did not differ between the control and high-dose vitamin C group under the > 24-g threshold (risk ratio, 0.83; 95% confidence interval, 0.68–1.02; p = 0.068). Conclusions High-dose vitamin C therapy was associated with reduced mortality in patients with severe burns when used under a minimum threshold of 10 g within the first 2 days of admission. While “high-dose” vitamin C therapy lacks a universal definition, the present study reveals that different “high-dose” regimens may yield improved outcomes.

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A prospective observation on nutrition support in adult patients with severe burns

British Journal Of Nutrition ◽

10.1017/s0007114519000217 ◽

2019 ◽

Vol 121 (09) ◽

pp. 974-981 ◽

Cited By ~ 1

Author(s):

Fengmei Guo ◽

Hua Zhou ◽

Jian Wu ◽

Yingzi Huang ◽

Guozhong Lv ◽

...

Keyword(s):

Hospital Mortality ◽

Burn Injury ◽

Early Stage ◽

Energy Requirement ◽

Total Body Surface Area ◽

Nutrition Therapy ◽

Nutrition Support ◽

Burn Patients ◽

Severe Burn ◽

Severe Burns

AbstractNutrition therapy is considered an important treatment of burn patients. The aim of the study was to delineate the nutritional support in severe burn patients and to investigate association between nutritional practice and clinical outcomes. Severe burn patients were enrolled (n 100). In 90 % of the cases, the burn injury covered above 70 % of the total body surface area. Mean interval from injury to nutrition start was 2·4 (sd 1·1) d. Sixty-seven patients were initiated with enteral nutrition (EN) with a median time of 1 d from injury to first feed. Twenty-two patients began with parenteral nutrition (PN). During the study, thirty-two patients developed EN intolerance. Patients received an average of about 70 % of prescribed energy and protein. Patients with EN providing <30 % energy had significantly higher 28- d and in-hospital mortality than patients with EN providing more than 30 % of energy. Mortality at 28 d was 11 % and in-hospital mortality was 45 %. Multiple regression analysis demonstrated that EN providing <30 % energy and septic shock were independent risk factors for 28- d prognosis. EN could be initiated early in severe burn patients. Majority patients needed PN supplementation for energy requirement and EN feeding intolerance. Post-pyloric feeding is more efficient than gastric feeding in EN tolerance and energy supplement. It is difficult for severe burn patients to obtain enough feeding, especially in the early stage of the disease. More than 2 weeks of underfeeding is harmful to recovery.

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High Dose Ascorbic Acid During Acute Resuscitation in Critically Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab088 ◽

2021 ◽

Author(s):

Eva Flores ◽

Manuel Sánchez-Sánchez ◽

Claudio Gutierrez ◽

Belen Estébanez ◽

Pablo Millán ◽

...

Keyword(s):

Ascorbic Acid ◽

Kidney Injury ◽

Severity Index ◽

Free Radical Scavenger ◽

Control Group ◽

Radical Scavenger ◽

High Dose ◽

Burn Patients ◽

Severe Burn ◽

Retrospective Case

ABTRACT Ascorbic acid (AA) is a potent oxygen–free radical scavenger. We hypothesised that treating severe burn patients with high doses of AA (HDAA) can reduce fluid resuscitation requirements and prevent organ dysfunction. We performed a unicentric, retrospective case control study of 75 burn patients: 25 patients admitted from 2018–2019 with more than 30% Total Surface Body Surface Area (TSBA) burned who received HDAA (66 mg/kg/hr. as soon as possible after admission until 36 hr. after injury), and 50 patients admitted from 2014–2017 with similar Abbreviated Burn Severity Index (ABSI)/Baux scores who were treated with the same protocol but did not receive HDAA. During the first 24 hours of burn resuscitation the HDAA group required less fluids than the control group (3.06 ± 0.87 ml/kg /%TBSA vs 4.32 ± 1.51 p < 0.05), but the overall reduction of fluid requirements during the first 72 hours was not significant. There were no significant differences in Sequential Organ Failure Assessment (SOFA), other haemodynamic parameters, complications or mortality. We also did not find an increase acute kidney injury in patients who received HDAA even though the mean urine oxalate/ creatinine ratio was 0.61 (0.02–0.96). We conclude that in severe burn patients treated with a restrictive fluid therapy protocol, administration of HDAA can decrease only the initial fluid requirements but not total fluid intakes. We did not find differences in severity score after resuscitation or in mortality. Nor did we find an increase in renal failure in patients administered with HDAA.

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Safety and Effectiveness of High-Dose Vitamin C in Patients with COVID-19; A Randomized Controlled open-label Clinical Trial ‎

10.21203/rs.3.rs-139942/v1 ◽

2021 ◽

Author(s):

Saeidreza JamaliMoghadamSiahkali ◽

Besharat Zarezade ◽

Sogol Koolaji ◽

Seyed Ahmad Seyed Alinaghi ◽

Abolfazl Zendehdel ◽

...

Keyword(s):

Vitamin C ◽

Controlled Trial ◽

Control Treatment ◽

Control Group ◽

P Value ◽

Case Group ◽

High Dose ◽

Open Label ◽

Significant Difference ◽

High Dose Vitamin

Abstract Background: To assess the effectiveness of vitamin C treatment against coronavirus disease 2019 (COVID-19)Methods: An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received high-dose of vitamin C (six gr daily) added to the same regimen. Results: There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. On the 3rd day of hospitalization, the mean core body temperatures was significantly lower and SpO2 was higher In the case group (p value = 0.001, and 0.014, respectively). The median length of hospitalization in case group which was significantly longer than the control group (8.5 days vs. 6.5 days) (p value = 0.0280). There was no significant difference in SpO2 levels at discharge time, the length of ICU stay, and mortality between the two groups.Conclusions: We did not find significantly better outcomes in the group who were treated with high-dose vitamin C in addition to the main treatment regimen at discharge.Trial registration: The project was registered by Iranian Registry of Clinical Trials.IRCT20200411047025N1

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Efficacy of Using High-Dose Vitamin C, Thiamine, and Hydrocortisone in Sepsis and Septic Shock: A Retrospective Before-After Study

10.21203/rs.3.rs-487165/v1 ◽

2021 ◽

Author(s):

Haytham Wali ◽

William Malik ◽

Juliane Mayette

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Vitamin C ◽

Hospital Mortality ◽

Multiorgan Failure ◽

Kidney Injury ◽

P Value ◽

Permeability Barrier ◽

High Dose ◽

High Dose Vitamin

Abstract Background/Objective Sepsis can be associated with increased production of reactive oxygen species that deplete antioxidant molecules and increase the consumption of vitamin C, which correlates with multiorgan failure and death. Intravenous vitamin C may protect several microvascular functions, including capillary blood flow, microvascular permeability barrier, and arteriolar responsiveness to vasoconstrictors and vasodilators. This study was conducted to assess the practice of administering high-dose vitamin C in critically ill patients with sepsis or septic shock at our institution retrospectively.Methods We conducted an electronic health record (EHR)-based, retrospective, before-after study. The primary objective was to assess the efficacy of using a high-dose vitamin C regimen in decreasing hospital mortality. A two-sided P-value of < 0.05 was considered statistically significant.Results A total of 84 patient records were included in this study. Administration of high-dose vitamin C, thiamine, and hydrocortisone was associated with higher hospital mortality (64.3% versus 42.9%; P = 0.049), higher ICU mortality (59.5% versus 42.9%; P = 0.07), shorter ICU length of stay (three versus seven days; P = 0.53), higher incidence of acute kidney injury (61.9% versus 26.2%; P = 0.001), and a higher requirement for renal replacement therapy (76.9% versus 45.5%; P = 0.06).Conclusion Administration of high-dose vitamin C, thiamine, and hydrocortisone in critical care patients with sepsis or septic shock was associated with higher hospital mortality and higher incidence of acute kidney injury.

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Pengaruh vitamin C dosis tinggi terhadap peroksidasi lipid dan penyembuhan luka pasca tonsilektomi

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v47i1.196 ◽

2017 ◽

Vol 47 (1) ◽

pp. 58

Author(s):

Viika Miftakhul Umami ◽

Suprihati Suprihati ◽

Farokah Farokah

Keyword(s):

Lipid Peroxidation ◽

Wound Healing ◽

Vitamin C ◽

Rating Scale ◽

Pain Scale ◽

T Test ◽

Control Group ◽

High Dose ◽

Decrease Lipid Peroxidation ◽

High Dose Vitamin

Latar belakang: Tonsilitis kronik menyebabkan terbentuknya oksidan, salah satunya peroksidasilipid. Vitamin C dosis tinggi pasca tonsilektomi sebagai antioksidan diduga dapat menurunkan kadarperoksidasi lipid dan mempercepat penyembuhan luka.Tujuan: Membuktikan pengaruh vitamin Cdosis tinggi dapat mempercepat penyembuhan luka dan menurunkan kadar peroksidasi lipid pascatonsilektomi.Metode: Penelitian dengan desain randomized controlled trial (RCT). Empat puluh subjekyang memenuhi kriteria inklusi dan eksklusi di klinik Telinga Hidung Tenggorok – Bedah Kepala LeherRumah Sakit Soeselo Slawi dibagi dua, yaitu kelompok yang mendapat vitamin C dosis tinggi segerapasca tonsilektomi dan terapi standar (amoksisilin dan parasetamol), kelompok kontrol ndapat terapistandar. Kadar peroksidasi lipid dievaluasi sebelum tonsilektomi dan 2 minggu pasca tonsilektomi. Derajatnyeri dinilai dengan visual analogue scale (VAS) atau wong baker faces pain rating scale (WBFPRS)dan derajat epitelisasi dinilai pada hari ke-1, 4, 7, dan 14 pasca tonsilektomi. Data dianalisis dengan ujit berpasangan, uji t tidak berpasangan, dan uji Mann-Whitney.Hasil: Empat puluh subjek dapat diikutisampai akhir penelitian. Vitamin C dosis tinggi dapat mengurangi derajat nyeri sejak hari keempatpasca tonsilektomi (p<0,05), dan mempercepat derajat epitelisasi sejak hari pertama pasca tonsilektomi(p<0,05), serta lebih banyak sembuh pada hari ke-14 pasca tonsilektomi (p=0,002). Peroksidasi lipidserum 2 minggu pasca tonsilektomi pada kelompok vitamin C dosis tinggi cenderung lebih banyak yangturun dibanding kelompok kontrol (p=0,057). Kesimpulan: Vitamin C dosis tinggi dapat mempercepatpenyembuhan luka dan menurunkan kadar peroksidasi lipid pasca tonsilektomi.Kata kunci : Vitamin C, peroksidasi lipid, penyembuhan luka, pasca tonsilektomi ABSTRACTBackground: Chronic tonsillitis results oxidation products, one of them is lipid peroxidation.High dose vitamin C post tonsillectomy as antioxidant estimated decrease lipid peroxidation level andaccelerate wound healing. Purpose: To investigate the effect of high dose vitamin C to accelerate woundhealing and decrease lipid peroxidation level in post tonsillectomy patients. Methods: A randomizedcontrolled trial design involved fourty subjects at ENT-HNS clinic of Soeselo Slawi Hospital. The subjectswere divided into the study group who received high dose vitamin C immediately after tonsillectomy andstandart treatment (amoxicillin and paracetamol), the control group who received standart treatment. Lipidperoxidation level was observed at pre and 2 weeks post tonsillectomy, while pain scale (VAS/WBFPRS)and wound epithelialization were observed at 1st, 4th, 7th, and 14th days post tonsillectomy. Data wereanalized with independent-sample t test, paired-sample t test, and Mann-Whitney test.Results: Fourtysubjects were followed until the study finished. High dose vitamin C decreased pain scale since 4 dayspost tonsillectomy (p<0,05), could accelerate wound epithelialization since first day post tonsillectomy(p<0,05), and the most patients recovered at 14th days post tonsillectomy (p=0,002). Lipid peroxidationlevel at 2 weeks post tonsillectomy in high dose vitamin C group tend to lower than the control group(p=0,057). Conclusion: High dose vitamin C post tonsillectomy can accelerate wound healing anddecrease lipid peroxidation level post tonsillectomy.Key words: Vitamin C, lipid peroxidation, wound healing, post tonsillectomy

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Pilot trial of high-dose vitamin C in critically ill COVID-19 patients

Annals of Intensive Care ◽

10.1186/s13613-020-00792-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jing Zhang ◽

Xin Rao ◽

Yiming Li ◽

Yuan Zhu ◽

Fang Liu ◽

...

Keyword(s):

Vitamin C ◽

Organ Failure ◽

Critically Ill ◽

Day Treatment ◽

Invasive Mechanical Ventilation ◽

Pilot Trial ◽

Control Group ◽

Controlled Clinical Trial ◽

High Dose ◽

High Dose Vitamin

Abstract Background Few specific medications have been proven effective for the treatment of patients with severe coronavirus disease 2019 (COVID-19). Here, we tested whether high-dose vitamin C infusion was effective for severe COVID-19. Methods This randomized, controlled, clinical trial was performed at 3 hospitals in Hubei, China. Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ICU were randomly assigned in as 1:1 ratio to either the high-dose intravenous vitamin C (HDIVC) or the placebo. HDIVC group received 12 g of vitamin C/50 ml every 12 h for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way within 48 h of arrival to ICU. The primary outcome was invasive mechanical ventilation-free days in 28 days (IMVFD28). Secondary outcomes were 28-day mortality, organ failure (Sequential Organ Failure Assessment (SOFA) score), and inflammation progression (interleukin-6). Results Only 56 critical COVID-19 patients were ultimately recruited due to the early control of the outbreak. There was no difference in IMVFD28 between two groups (26.0 [9.0–28.0] in HDIVC vs 22.0 [8.50–28.0] in control, p = 0.57). HDIVC failed to reduce 28-day mortality (P = 0.27). During the 7-day treatment period, patients in the HDIVC group had a steady rise in the PaO2/FiO2 (day 7: 229 vs. 151 mmHg, 95% CI 33 to 122, P = 0.01), which was not observed in the control group. IL-6 in the HDIVC group was lower than that in the control group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P = 0.04) on day 7. Conclusion This pilot trial showed that HDIVC failed to improve IMVFD28, but might show a potential signal of benefit in oxygenation for critically ill patients with COVID-19 improving PaO2/FiO2 even though.

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Controversy Continues Over Use of High-Dose Vitamin C as Cancer Tx

Internal Medicine News ◽

10.1016/s1097-8690(05)70290-0 ◽

2005 ◽

Vol 38 (7) ◽

pp. 40

Author(s):

NANCY WALSH

Keyword(s):

Vitamin C ◽

High Dose ◽

High Dose Vitamin

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Single High-Dose Vitamin D Supplementation as an Approach for Reducing Ultramarathon-Induced Inflammation: A Double-Blind Randomized Controlled Trial

Nutrients ◽

10.3390/nu13041280 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1280

Author(s):

Jan Mieszkowski ◽

Andżelika Borkowska ◽

Błażej Stankiewicz ◽

Andrzej Kochanowicz ◽

Bartłomiej Niespodziński ◽

...

Keyword(s):

Vitamin D ◽

Inflammatory Marker ◽

Controlled Trial ◽

Vitamin D Supplementation ◽

Oncostatin M ◽

Control Group ◽

High Dose ◽

Double Blind ◽

Single High Dose ◽

High Dose Vitamin

Purpose: A growing number of studies indicate the importance of vitamin D supplementation for sports performance. However, the effects of a single high-dose vitamin D supplementation on ultramarathon-induced inflammation have not been investigated. We here analyzed the effect of a single high-dose vitamin D supplementation on the inflammatory marker levels in ultramarathon runners after an ultramarathon run (maximal run 240 km). Methods: In the study, 35 runners (amateurs) were assigned into two groups: single high-dose vitamin D supplementation group, administered vitamin D (150,000 IU) in vegetable oil 24 h before the start of the run (n = 16); and placebo group (n = 19). Blood was collected for analysis 24 h before, immediately after, and 24 h after the run. Results: Serum 25(OH)D levels were significantly increased after the ultramarathon in both groups. The increase was greater in the vitamin D group than in the control group. Based on post-hoc and other analyses, the increase in interleukin 6 and 10, and resistin levels immediately after the run was significantly higher in runners in the control group than that in those in the supplementation group. Leptin, oncostatin M, and metalloproteinase tissue inhibitor levels were significantly decreased in both groups after the run, regardless of the supplementation. Conclusions: Ultramarathon significantly increases the serum 25(OH)D levels. Attenuation of changes in interleukin levels upon vitamin D supplementation confirmed that vitamin D has anti-inflammatory effect on exercise-induced inflammation.

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Protective effects and mechanisms of high-dose vitamin C on sepsis-associated cognitive impairment in rats

Scientific Reports ◽

10.1038/s41598-021-93861-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ning Zhang ◽

Wei Zhao ◽

Zhen-Jie Hu ◽

Sheng-Mei Ge ◽

Yan Huo ◽

...

Keyword(s):

Vitamin C ◽

Escape Latency ◽

Morris Water Maze Test ◽

Protective Mechanism ◽

High Dose ◽

Maze Test ◽

Tnf Α ◽

Histopathologic Changes ◽

High Dose Vitamin ◽

Necrosis Factor

AbstractSepsis survivors present long-term cognitive deficits. The present study was to investigate the effect of early administration of high-dose vitamin C on cognitive function in septic rats and explore its possible cerebral protective mechanism. Rat sepsis models were established by cecal ligation and puncture (CLP). Ten days after surgery, the Morris water maze test was performed to evaluate the behavior and cognitive function. Histopathologic changes in the hippocampus were evaluated by nissl staining. The inflammatory cytokines, activities of antioxidant enzymes (superoxide dismutase or SOD) and oxidative products (malondialdehyde or MDA) in the serum and hippocampus were tested 24 h after surgery. The activity of matrix metalloproteinase-9 (MMP-9) and expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1(HO-1) in the hippocampus were measured 24 h after surgery. Compared with the sham group in the Morris water maze test, the escape latency of sepsis rats was significantly (P = 0.001) prolonged in the navigation test, whereas the frequency to cross the platform and the time spent in the target quadrant were significantly (P = 0.003) reduced. High-dose vitamin C significantly decreased the escape latency (P = 0.01), but increased the time spent in the target quadrant (P = 0.04) and the frequency to cross the platform (P = 0.19). In the CLP+ saline group, the pyramidal neurons were reduced and distributed sparsely and disorderly, the levels of inflammatory cytokines of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in the serum and hippocampus were significantly increased (P = 0.000), the blood brain barrier (BBB) permeability in the hippocampus was significantly (P = 0.000) increased, the activities of SOD in the serum and hippocampus were significantly (P = 0.000 and P = 0.03, respectively) diminished while the levels of MDA in the serum and hippocampus were significantly (P = 0.007) increased. High-dose vitamin C mitigated hippocampus histopathologic changes, reduced systemic inflammation and neuroinflammation, attenuated BBB disruption, inhibited oxidative stress in brain tissue, and up-regulated the expression of nuclear and total Nrf2 and HO-1. High-dose vitamin C significantly (P < 0.05) decreased the levels of tumor necrosis factor- (TNF)-α, interleukin-6 (IL-6), MDA in the serum and hippocampus, and the activity of MMP-9 in the hippocampus, but significantly (P < 0.05) increased the levels of SOD, the anti-inflammatory cytokine (IL-10) in the serum and hippocampus, and nuclear and total Nrf2, and HO-1 in the hippocampus. In conclusion, high-dose vitamin C can improve cognition impairment in septic rats, and the possible protective mechanism may be related to inhibition of inflammatory factors, alleviation of oxidative stress, and activation of the Nrf2/HO-1 pathway.

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