Vitamin C administration worsens outcomes of sepsis patients on vasopressor therapy: NEJM

USA: In a new study published in The New England Journal of Medicine shows that adults with sepsis following vasopressor therapy in the ICU had a greater risk of death or chronic organ failure at 28 days when receiving intravenous vitamin C compared to those receiving a placebo.

Mixed results have been found in studies examining the effects of intravenous vitamin C in sepsis-affected people undergoing vasopressor therapy in the intensive care unit (ICU). These studies looked at the risk of death and organ failure.

Adults who had been in the intensive care unit (ICU) for no more than 24 hours, had a confirmed or suspected infection as the primary diagnosis, and were taking a vasopressor were randomly assigned to receive an infusion of vitamin C (at a dose of 50 mg per kilogram of body weight) or a matched placebo every six hours for up to 96 hours. On day 28, the primary outcome was defined as a composite of death or persistent organ failure (defined as the need for vasopressors, invasive mechanical ventilation, or new renal replacement therapy).

The key findings of this study were as follow:

1. Randomization was performed on a total of 872 subjects.

2. In the vitamin C group, 191 of 429 patients (44.5%) experienced the primary outcome, while 167 of 434 patients (38.5%) experienced it in the control group.

3. At 28 days, deaths had occurred in 152 of the 429 patients (35.4%) who had received vitamin C and in 137 of the 434 patients (31.6%) who had received a placebo.

4. Persistent organ dysfunction had occurred in 39 of the 429 patients (9.1%) and in 30 of the 434 patients (6.9%) in the vitamin C group and the placebo group, respectively.

5. The results for organ-dysfunction scores, biomarkers, health-related quality of life, 6-month survival, stage 3 acute renal damage, and hypoglycemia episodes were comparable across the two groups.

6. One patient in the vitamin C group experienced a major episode of hypoglycemia, while another experienced a serious anaphylactic reaction.

"The findings of this study suggests that when given to sepsis patients in the intensive care unit, vitamin C was proven to be significantly harmful," said the Authors in conclusion.

Reference:

Lamontagne, F., Masse, M.-H., Menard, J., Sprague, S., Pinto, R., Heyland, D. K., Cook, D. J., Battista, M.-C., Day, A. G., Guyatt, G. H., Kanji, S., McGuinness, S. P., … Adhikari, N. K. J. (2022). Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2200644