/ Kwangmoo, stockadobecom
Quebec / Canada – The prospect of improving the prognosis of patients with life-threatening sepsis with high doses of vitamin C has not materialized in a randomized study. According to a publication in New England Journal of Medicine (2022; DOI: 10.1056 / NEJMoa2200644) organ failure or patient death were even more common.
Sepsis is the most serious complication of infectious disease and one of the leading causes of death in hospitals. This is due to an overloaded immune system that is no longer able to control pathogens. A severe immune response can ultimately do more harm than good to the body. Vitamin C treatment is based on the observation that the immune system needs more vitamin. In the end, it could no longer be available in sufficient quantities. This is supported by the low serum concentrations of many critically ill patients.
In recent years, studies have repeatedly tried to improve the situation of patients with cheap vitamin, which is also classified as harmless in large quantities. However, convincing results have not been achieved.
Now the initiative of Canadian intensive care physicians has failed. For the LOVIT (Lessening Organ Dysfunction With Vitamin C) study, the Canadian Critical Care Trials Group included 872 patients who were in intensive care due to sepsis for less than 1 day and already required vasopressor circulatory support, randomized to a high-dose vitamin C or placebo group. . Vitamin C infusions of 50 mg / kg body weight were repeated every 6 hours (up to a maximum of 96 hours).
Treatment with high doses of vitamin C resulted in more deaths
The hope was to prevent organ failure and the patient’s death. That didn’t work. According to Francois Lamontagne of the Université de Sherbrooke in Quebec and colleagues, the patient died more often within the first 28 days or there were persistent organ disorders. This primary endpoint of the study occurred in 191 of 429 patients (44.5%) in the vitamin C group compared to 167 of 434 patients (38.5%) in the control group. The risk ratio of 1.21 was even significant with a 95% confidence interval of 1.04 to 1.40. The disadvantage was mainly caused by patients with persistent organ dysfunction (9.1% versus 6.9%; risk ratio 1.30; 0.83-2.05). The risk of death (35.4% versus 31.6%; risk ratio 1.17; 0.98-1.40) also tended to be higher.
Physicians were unable to determine the cause of the adverse effects of high-dose vitamin C treatment. There were no differences in biomarkers for tissue dysoxia (lactate), inflammation (interleukin 1beta, tumor necrosis factor-alpha) or endothelial damage (thrombomodulin, angiopoietin-2). The only discrepancies were a tendency to increase hypoglycemia (6.1% versus 5.1%; hazard ratio 1.25; 0.73-2.14) and an anaphylactic reaction in the vitamin C group.
Further insights into the efficacy and safety of high-dose vitamin C therapy in intensive care patients are expected from the REMAP-CAP study and the LOVIT-COVID study in patients with COVID-19. A French study examines the effects of acute lung failure. © rme / aerzteblatt.de