Safety and Effectiveness of High-dose Vitamin C in Patients with COVID-19: a Randomized Open-label Clinical Trial

Overview

Journal Eur J Med Res

Publisher Biomed Central

Specialty General Medicine

Date 2021 Feb 12

PMID 33573699

Citations 83

Authors

Saeidreza Jamalimoghadamsiahkali

Besharat Zarezade

Sogol Koolaji

SeyedAhmad SeyedAlinaghi

Abolfazl Zendehdel

Mohammad Tabarestani

Ehsan Sekhavati Moghadam

Ladan Abbasian

Seyed Ali Dehghan Manshadi

Mohamadreza Salehi

Malihe Hasannezhad

Sara Ghaderkhani

Mohsen Meidani

Faeze Salahshour

Fatemeh Jafari

Navid Manafi

Fereshteh Ghiasvand

Affiliations

Soon will be listed here.

Abstract

Background: Vitamin C is an essential water-soluble nutrient that functions as a key antioxidant and has been proven to be effective for boosting immunity. In this study, we aimed to assess the efficacy of adding high-dose intravenous vitamin C (HDIVC) to the regimens for patients with severe COVID-19 disease.

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 HDIVC (6 g 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. The mean body temperature was significantly lower in the case group on the 3rd day of hospitalization (p = 0.001). Peripheral capillary oxygen saturations (SpO) measured at the 3rd day of hospitalization was also higher in the case group receiving HDIVC (p = 0.014). The median length of hospitalization in the case group was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in SpO levels at discharge time, the length of intensive care unit (ICU) stay, and mortality between the two groups.

Conclusions: We did not find significantly better outcomes in the group who were treated with HDIVC in addition to the main treatment regimen at discharge. Trial registration irct.ir (IRCT20200411047025N1), April 14, 2020.

Citing Articles

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Role of intravenous vitamin C on outcomes in hospitalized patients with moderate or severe COVID-19: a real life data of Turkish patients.

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PMID: 39295660 PMC: 11410453. DOI: 10.7759/cureus.67184.

References

Sherman D, Keaney Jr J, Biegelsen E, Duffy S, COFFMAN J, Vita J . Pharmacological concentrations of ascorbic acid are required for the beneficial effect on endothelial vasomotor function in hypertension. Hypertension. 2000; 35(4):936-41. DOI: 10.1161/01.hyp.35.4.936. View

Fisher B, Seropian I, Kraskauskas D, Thakkar J, Voelkel N, Fowler 3rd A . Ascorbic acid attenuates lipopolysaccharide-induced acute lung injury. Crit Care Med. 2011; 39(6):1454-60. DOI: 10.1097/CCM.0b013e3182120cb8. View

Padayatty S, Sun H, Wang Y, Riordan H, Hewitt S, Katz A . Vitamin C pharmacokinetics: implications for oral and intravenous use. Ann Intern Med. 2004; 140(7):533-7. DOI: 10.7326/0003-4819-140-7-200404060-00010. View

Wu R, Wang L, Kuo H, Shannar A, Peter R, Chou P . An Update on Current Therapeutic Drugs Treating COVID-19. Curr Pharmacol Rep. 2020; 6(3):56-70. PMC: 7211915. DOI: 10.1007/s40495-020-00216-7. View

Zhang J, Rao X, Li Y, Zhu Y, Liu F, Guo G . Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. Ann Intensive Care. 2021; 11(1):5. PMC: 7794643. DOI: 10.1186/s13613-020-00792-3. View

Hemila H, Chalker E . Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis. Nutrients. 2019; 11(4). PMC: 6521194. DOI: 10.3390/nu11040708. View

Du W, Yuan Z, Sun J, Tang J, Cheng A, Shen D . Therapeutic efficacy of high-dose vitamin C on acute pancreatitis and its potential mechanisms. World J Gastroenterol. 2003; 9(11):2565-9. PMC: 4656542. DOI: 10.3748/wjg.v9.i11.2565. View

Scholz S, Borgstedt R, Ebeling N, Menzel L, Jansen G, Rehberg S . Mortality in septic patients treated with vitamin C: a systematic meta-analysis. Crit Care. 2021; 25(1):17. PMC: 7787590. DOI: 10.1186/s13054-020-03438-9. View

Fowler 3rd A, Syed A, Knowlson S, Sculthorpe R, Farthing D, DeWilde C . Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014; 12:32. PMC: 3937164. DOI: 10.1186/1479-5876-12-32. View

10.

Borrelli E, Roux-Lombard P, Grau G, Girardin E, Ricou B, Dayer J . Plasma concentrations of cytokines, their soluble receptors, and antioxidant vitamins can predict the development of multiple organ failure in patients at risk. Crit Care Med. 1996; 24(3):392-7. DOI: 10.1097/00003246-199603000-00006. View

11.

Farjana M, Moni A, Sohag A, Hasan A, Hannan M, Hossain M . Repositioning Vitamin C as a Promising Option to Alleviate Complications associated with COVID-19. Infect Chemother. 2020; 52(4):461-477. PMC: 7779993. DOI: 10.3947/ic.2020.52.4.461. View

12.

Li J . Evidence is stronger than you think: a meta-analysis of vitamin C use in patients with sepsis. Crit Care. 2018; 22(1):258. PMC: 6180524. DOI: 10.1186/s13054-018-2191-x. View

13.

Berger M, Oudemans-van Straaten H . Vitamin C supplementation in the critically ill patient. Curr Opin Clin Nutr Metab Care. 2015; 18(2):193-201. DOI: 10.1097/MCO.0000000000000148. View

14.

Polidori M, Mecocci P, Levine M, Frei B . Short-term and long-term vitamin C supplementation in humans dose-dependently increases the resistance of plasma to ex vivo lipid peroxidation. Arch Biochem Biophys. 2004; 423(1):109-15. DOI: 10.1016/j.abb.2003.12.019. View

15.

Mikirova N, Hunninghake R . Effect of high dose vitamin C on Epstein-Barr viral infection. Med Sci Monit. 2014; 20:725-32. PMC: 4015650. DOI: 10.12659/MSM.890423. View

16.

Messina G, Polito R, Monda V, Cipolloni L, Di Nunno N, Di Mizio G . Functional Role of Dietary Intervention to Improve the Outcome of COVID-19: A Hypothesis of Work. Int J Mol Sci. 2020; 21(9). PMC: 7247152. DOI: 10.3390/ijms21093104. View

17.

Kennes B, Dumont I, Brohee D, Hubert C, Neve P . Effect of vitamin C supplements on cell-mediated immunity in old people. Gerontology. 1983; 29(5):305-10. DOI: 10.1159/000213131. View

18.

Altschul D, Unda S, Benton J, De La Garza Ramos R, Cezayirli P, Mehler M . A novel severity score to predict inpatient mortality in COVID-19 patients. Sci Rep. 2020; 10(1):16726. PMC: 7542454. DOI: 10.1038/s41598-020-73962-9. View

19.

Rice M, Russo-Menna I . Differential compartmentalization of brain ascorbate and glutathione between neurons and glia. Neuroscience. 1998; 82(4):1213-23. DOI: 10.1016/s0306-4522(97)00347-3. View

20.

Hemila H, Chalker E . Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis. J Intensive Care. 2020; 8:15. PMC: 7006137. DOI: 10.1186/s40560-020-0432-y. View