Pilot trial of high-dose vitamin C in critically ill COVID-19 patients

Annals of Intensive Care - Tập 11 Số 1 - 2021
Jing Zhang1, Xiaolan Rao1, Yiming Li1, Yibin Zhu1, Fang Liu1, Guangling Guo2, Guopei Luo3, Meng Zhao4, Daniel De Backer5, Hui Xiang6, Zhiyong Peng6
1Dept. of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
2Anti-Aging Medical Center, Taihe Hospital, Huibei University of Medicine, Shiyan, 442000, Hubei, China
3Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Huibei University of Medicine, Shiyan, 442000, Hubei, China
4Department of Infectious Diseases, Taihe Hospital, Huibei University of Medicine, Shiyan, 442000, Hubei, China
5Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
6Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, Hubei, China

Tóm tắt

Abstract Background

Few specific medications have 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.

Methods

This 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 h for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way within 48 h of arrival to ICU. The primary outcome was invasive mechanical ventilation-free days in 28 days (IMVFD28). Secondary outcomes were 28-day mortality, organ failure (Sequential Organ Failure Assessment (SOFA) score), and inflammation progression (interleukin-6).

Results

Only 56 critical COVID-19 patients were ultimately recruited due to the early control of the outbreak. There was no difference in IMVFD28 between two groups (26.0 [9.0–28.0] in HDIVC vs 22.0 [8.50–28.0] in control, p = 0.57). HDIVC failed to reduce 28-day mortality (P = 0.27). 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), which was not observed in the control group. IL-6 in the HDIVC group was lower than that in the control group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P = 0.04) on day 7.

Conclusion

This pilot trial showed that HDIVC failed to improve IMVFD28, but might show a potential signal of benefit in oxygenation for critically ill patients with COVID-19 improving PaO2/FiO2 even though.

Từ khóa


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