Significant interference on specific point-of-care glucose measurements due to high dose of intravenous vitamin C therapy in critically ill patients

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Daan ten Berge ◽  
Wim Muller ◽  
Albertus Beishuizen ◽  
Alexander Daniel Cornet ◽  
Robbert Slingerland ◽  
...  
Keyword(s):  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
High Dose ◽  
Specific Point ◽  
Intravenous Vitamin ◽  
Significant Interference

scholarly journals High-dose vitamin C infusion for the treatment of critically ill COVID-19

2020 ◽  
Author(s):  
Jing Zhang ◽  
Xin Rao ◽  
Yiming Li ◽  
Yuan Zhu ◽  
Fang Liu ◽  
...  
Keyword(s):  
Placebo Group ◽  
Vitamin C ◽  
Critically Ill ◽  
Day Treatment ◽  
Invasive Mechanical Ventilation ◽  
Controlled Clinical Trial ◽  
High Dose ◽  
C 50 ◽  
Intravenous Vitamin ◽  
High Dose Vitamin

Abstract BackgroundNo specific medication has 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.MethodsThis 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 hours for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way. The primary outcome was invasive mechanical ventilation-free days in 28 days(IMVFD28). Secondary outcomes were 28-day mortality, organ failure, and inflammation progression.ResultsFifty-four critical COVID-19 patients were ultimately recruited. There was no difference in IMVFD28 between two groups. 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). Patients with SOFA scores ≥ 3 in the HDIVC group exhibited a significant reduction in 28-day mortality (P = 0.05) in univariate survival analysis. IL-6 in the VC group was lower than that in the placebo group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P = 0.04) on day 7.ConclusionThe addition of HDIVC may provide a protective clinical effect without any adverse events in critically ill patients with COVID-19.Clinicaltrial.gov identifer: NCT04264533

scholarly journals High-doses vitamin C improves cardiac injury through attenuating hyperinflammation in COVID-19

2021 ◽  
Author(s):  
Guozhi Xia ◽  
Di Fan ◽  
Chaoran Ma ◽  
Yanru He ◽  
Yaohu Zhu ◽  
...  
Keyword(s):  
Vitamin C ◽  
Critically Ill ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Troponin I ◽  
Cardiac Injury ◽  
High Dose ◽  
High Doses ◽  
Intravenous Vitamin

Background: Cardiac injury is common and associated with worse clinical outcomes in COVID-19. Data are lacking whether high-dose intravenous vitamin C (HIVC) could help to improve cardiac injury in the pandemic. Methods: The study included severe and critically ill COVID-19 with cardiac injury. Troponin I and inflammatory markers were collected at admission and 14 days after treatment with HIVC along with symptomatic supportive treatment from the electronic medical records. Results: The patients (n = 113) were categorized into the improved cardiac injury (ICI) group (n = 70) and the non-improved cardiac injury (NICI) group (n = 43). Overall, 51 (45.1%) patients were administrated with HIVC, the percentages of patients with HIVC were higher in the ICI group than those in the NICI group. Logistic regression analysis revealed that HIVC was independently associated with improved cardiac injury. Further analysis showed that inflammatory markers levels significantly decreased at 14 days after treatment with HIVC compared to those without HIVC. Meanwhile, similar results were also observed regarding changes in inflammatory markers levels from baseline to 14 days after treatment with HIVC. Conclusions: HIVC can improve cardiac injury through attenuating hyperinflammation in severe and critically ill patients with COVID-19.

scholarly journals Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit: a preliminary study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ata Mahmoodpoor ◽  
Kamran Shadvar ◽  
Sarvin Sanaie ◽  
Mir Reza Hadipoor ◽  
Mohammad Ata Pourmoghaddam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intervention Group ◽  
Severe Pneumonia ◽  
High Dose ◽  
Significant Difference ◽  
Vasopressor Use

Abstract Background Critically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia. Methods Eighty critically ill patients with pneumonia were enrolled in this randomized double-blinded clinical trial. Patients with a CURB-65 score > 3, one major criterion, or ≥ 3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as a continuous infusion or normal saline in the same volume correspondingly for 96 h. Serum levels of vitamin C were noted at baseline and 48 h after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2, and mortality rate were noted for all patients till the 28th day. Any complications related to the vitamin C administration were recorded. Results Duration of mechanical ventilation and vasopressor use were significantly lower in the intervention group (p: < 0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have a significant difference but its levels increased in the intervention group and decreased in the control group during the study period. Mortality rate insignificantly decreased in the intervention group (p = 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C. Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation, and vasopressor use without any significant effect on mortality. Trial registration: IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, Seied Hadi Saghaleini.

scholarly journals Use of Intravenous Vitamin C in Critically Ill Patients With COVID-19 Infection

2021 ◽  
pp. 089719002110150
Author(s):  
Matthew Li ◽  
Tsung Han Ching ◽  
Christopher Hipple ◽  
Ricardo Lopez ◽  
Asad Sahibzada ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Objective ◽  
Primary Study ◽  
Protective Effects ◽  
Icu Length Of Stay ◽  
Intravenous Vitamin

Introduction The pathophysiology for Coronavirus Disease 2019 (COVID-19) infection is characterized by cytokine oxidative stress and endothelial dysfunction. Intravenous (IV) vitamin C has been utilized as adjuvant therapy in critically ill patients with sepsis for its protective effects against reactive oxygen species and immunomodulatory effects. The primary objective of this study was to evaluate the effects of IV vitamin C in critically ill patients with COVID-19 infection. Methods Retrospective observational cohort study with propensity score matching of intensive care unit (ICU) patients who received 1.5 grams IV vitamin C every 6 hours for up to 4 days for COVID-19 infection. The primary study outcome was in-hospital mortality. Secondary outcomes included vasopressor requirements in norepinephrine equivalents, ICU length of stay, and change in Sequential Organ Failure Assessment (SOFA) score. Results Eight patients received IV vitamin C and were matched to 24 patients. Patients in the IV vitamin C group had higher rates of hospital mortality [7 (88%) vs. 19 (79%), P = 0.049]. There was no difference in the daily vasopressor requirement in the treatment group or between the 2 groups. The mean SOFA scores post-treatment was higher in the IV vitamin C group (12.4 ± 2.8 vs. 8.1 ± 3.5, P < 0.005). There was no difference in ICU length of stay between the treatment and control groups. Conclusion Adjunctive IV vitamin C for the management of COVID-19 infection in critically ill patients may not decrease the incidence of mortality, vasopressor requirements, SOFA scores, or ventilator settings.

scholarly journals Safety of High-Dose Vitamin C in Critically Ill Patients: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Dhan Bahadur Shrestha ◽  
Pravash Budhathoki ◽  
Yub Raj Sedhai ◽  
Sujit Kumar Mandal ◽  
Shreeja Shikhrakar ◽  
...  
Keyword(s):  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Case Series ◽  
High Dose ◽  
Slight Reduction ◽  
Pooled Data

Abstract Objective:High-Dose Intravenous Vitamin C (HDIVC) is currently a controversial therapy for sepsis and ARDS. The published evidence regarding its efficacy in critically ill patients has shown conflicting results, and in fact, case reports have raised concerns for nephrotoxicity. The objective of this meta-analysis is to critically appraise the latest evidence regarding the safety of HDIVC in critically ill patients.Data Sources: Structured literature search on PubMed, PubMed Central, Scopus, Embase, and Google Scholar.Study Selection: Cross-sectional studies, case-control studies, cohort studies, randomized controlled trials, and case series with 20 or more critically ill patients who have received intravenous ascorbic acid (vitamin C), published till February 25, 2021. We identified 53 studies in our qualitative analysis and 48 studies in our quantitative analysis among a standardized search of 18,312 studies.Data Synthesis:We pooled data and calculated Odds Ratios (OR) and Mean Differences (MD) with their 95% confidence intervals to assess explanatory variables. Based on a random effect model from 33 studies, pooled hospital mortality outcomes showed a 19% reduction in odds for overall hospital mortality among the HDIVC group (OR, 0.81; 95% CI, 0.66-0.98). Mortality at 28/30-days, ICU mortality, length of hospital stay (LOS), new-onset AKI, and Renal Replacement Therapy (RRT) for AKI did not differ significantly across treatment and control groups. Pooled data from 30 studies disclosed 0.76 fewer ICU days in the HDIVC group than the placebo/ standard of care (SOC) group, 95% CI, -1.34 to -0.19. This significance persisted when we included RCTs only in the analysis (MD, -0.70; 95% CI, -1.39 to -0.02).Conclusions:Our results suggest that HDIVC treatment is renally safe and did not increase adverse kidney events, or mortality. It was associated with a slight reduction in ICU length of stay in critically ill patients.

scholarly journals Effects of a High Dose of Vitamin C along with Thiamine in Critically-ill Patients with Septic Shock: A Preliminary Study

2019 ◽  
pp. 1-7
Author(s):  
Hasanali Karimpour ◽  
Alireza Bahrami ◽  
Shila Amini ◽  
Mansour Rezaei ◽  
Javad Amini-Saman ◽  
...  
Keyword(s):  
Septic Shock ◽  
Vitamin C ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Lactate Concentration ◽  
Intervention Group ◽  
Treatment Modalities ◽  
Control Group ◽  
High Dose

Septic shock may occur in critically ill patients and despite antimicrobial treatment, it is associated with a high mortality rate. It is reasonable to look for new treatment modalities that might improve outcome. This is a randomized, double-blind control trial aiming at critically-ill septic patients in a tertiary hospital. Patients with quick sofa score of 2 and with organ dysfunction were included in this study. The intervention group received high doses of vitamin C at a dose of 50 mg/kg/four times daily along with thiamine at a dose of 200 mg/ twice daily) and the control group received normal saline for four days. The dose of vasopressors, procalcitonin and lactate clearance, and mean sequential organ failure assessment (SOFA) score were examined in the two groups. Patients were followed for 28 days. One hundred patients were allocated into two equal groups, and there was no difference between the two groups regarding baseline characteristics. Mean lactate concentration, SOFA score, days of antimicrobial therapy, and mortality at 28 days were similar between them. However, the mean procalcitonin concentration, and mean vasopressor treatment hours were significantly lower in the intervention group (p<0.05). Although Days of ICU stay were lower in the intervention group, It did not reach statistical significance. The results of this study showed that treatment with high dose vitamin C Reduces the vasopressor requirement without any effects on other parameters. Further studies with larger sample size are required for more generalizable results.

scholarly journals Rapid screening of critically ill patients for low plasma vitamin C concentrations using a point-of-care oxidation–reduction potential measurement

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Sander Rozemeijer ◽  
Bob Smit ◽  
Paul W. G. Elbers ◽  
Armand R. J. Girbes ◽  
Heleen M. Oudemans-van Straaten ◽  
...  
Keyword(s):  
Vitamin C ◽  
Diagnostic Accuracy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Reduction Potential ◽  
Point Of Care ◽  
Plasma Vitamin ◽  
Vitamin C Deficiency ◽  
Oxidation Reduction ◽  
Oxidation Reduction Potential

Abstract Background Hypovitaminosis C and vitamin C deficiency are common in critically ill patients and associated with organ dysfunction. Low vitamin C status often goes unnoticed because determination is challenging. The static oxidation reduction potential (sORP) reflects the amount of oxidative stress in the blood and is a potential suitable surrogate marker for vitamin C. sORP can be measured rapidly using the RedoxSYS system, a point-of-care device. This study aims to validate a model that estimates plasma vitamin C concentration and to determine the diagnostic accuracy of sORP to discriminate between decreased and higher plasma vitamin C concentrations. Methods Plasma vitamin C concentrations and sORP were measured in a mixed intensive care (IC) population. Our model estimating vitamin C from sORP was validated by assessing its accuracy in two datasets. Receiver operating characteristic (ROC) curves with areas under the curve (AUC) were constructed to show the diagnostic accuracy of sORP to identify and rule out hypovitaminosis C and vitamin C deficiency. Different cut-off values are provided. Results Plasma vitamin C concentration and sORP were measured in 117 samples in dataset 1 and 43 samples in dataset 2. Bias and precision (SD) were 1.3 ± 10.0 µmol/L and 3.9 ± 10.1 µmol/L in dataset 1 and 2, respectively. In patients with low plasma vitamin C concentrations, bias and precision were − 2.6 ± 5.1 µmol/L and − 1.1 ± 5.4 µmol in dataset 1 (n = 40) and 2 (n = 20), respectively. Optimal sORP cut-off values to differentiate hypovitaminosis C and vitamin C deficiency from higher plasma concentrations were found at 114.6 mV (AUC 0.91) and 124.7 mV (AUC 0.93), respectively. Conclusion sORP accurately estimates low plasma vitamin C concentrations and can be used to screen for hypovitaminosis C and vitamin C deficiency in critically ill patients. A validated model and multiple sORP cut-off values are presented for subgroup analysis in clinical trials or usage in clinical practice.

Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock.

2020 ◽  
Vol 22 (2) ◽  
pp. 174-174
Keyword(s):  
Septic Shock ◽  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pharmacokinetic Data ◽  
Icu Admission ◽  
Data Support ◽  
Intravenous Vitamin

Hudson EP, Collie JT, Fujii T, et al. Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock. Crit Care Resusc 2019; 21: 236-42. In this article, on page 238, Table 1 contained an error. Where it says “Time from randomisation to first dose of vitamin C (hours), median (IQR)”, it should read “Time from ICU admission to first dose of vitamin C (hours), median (IQR)”.

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