Clinical Efficacy and Safety of Vitamin C in the Treatment of Septic Shock Patients: Systematic Review and Meta-analysis

Background: Vitamin C deficiency is common in sepsis patients and is related to disease severity. At present, sepsis still has a high incidence and fatality rate. In sepsis, the body may develop microcirculation disorders and even develop organ failure. Exogenous vitamin C supplementation may be one of the effective adjuvant treatment measures for sepsis, which can not only improve the microcirculation of the body, but also affect the prognosis of patients by participating in the synthesis of norepinephrine, improving peripheral vascular resistance and increasing perfusion pressure. The efficacy and safety of vitamin C adjuvant therapy for septic shock are inconsistent in many studies, so it is very important to systematically evaluate the adjuvant effect of intravenous vitamin C in the treatment of septic shock.

Methods: Literature search of PubMed, EMBASE, The Cochrane Library, Web of Science, Wanfang, China Biology Medicine (CBM), and China National Knowledge Infrastructure (CNKI) electronic databases for vitamin C data since August 2021 for the treatment of patients with sepsis and septic shock. After screening, data extraction and quality evaluation were performed according to inclusion criteria, and meta-analysis was conducted using RevMan 5.3.

Results: The final 13 studies comprised 6 cohort studies and 7 randomized controlled trials (RCTs), with a total of 1,423 patients enrolled. Meta-analysis showed no significant effect of intravenous vitamin C on reducing in-hospital mortality rate [odds ratio (OR) =0.91, 95% confidence interval (CI): 0.76-1.08, P=0.27], intensive care unit (ICU) mortality rate (OR =0.84, 95% CI: 0.69-1.01, P=0.07), ICU stay (OR =0.88, 95% CI: 0.72-1.08, P=0.23) or total stay (OR =0.91, 95% CI: 0.68-1.21, P=0.51) in sepsis patients, nor did it improve the 72-h sequential organ failure assessment (72-h SOFA) score (OR =0.95, 95% CI: 0.77-1.18, P=0.66).

Discussion: Intravenous vitamin C showed no efficacy in the treatment of sepsis.