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The use of vitamin C in the intensive care unit during the COVID-19 pandemic

Year 2021, Volume 7, Issue 4, 425 - 431, 04.07.2021
https://doi.org/10.18621/eurj.938778

Abstract

Objectives: An exaggerated inflammatory immune response is observed in cases of COVİD 19. This study aims to evaluate the effects of vitamin C, as a significant modulator of inflammation, on the inflammatory parameters and mortality in patients followed up in the intensive care unit (ICU) during the pandemic.

Methods: This single-center retrospective study included 160 adult patients with confirmed positive nasopharyngeal smear COVID-19 PCR test results, who were followed up in the ICU between 01 March and 01 August 2020. Hospital files were scanned and patients given and not given vitamin C were assigned, to Group 1 and Group 2, respectively. The Acute Physiology and Chronic Health Evaluation (APACHE II) scores, the data entries on demographics, ventilation, laboratory tests, duration of ICU stay, discharge, and mortality were compared. Interventions with antiviral and antibacterial agents. steroids, cytokine apheresis, and renal replacement therapy were evaluated.

Results: Vitamin C treatment was started in patients with raised neutrophil/lymphocyte ratio (NLR) at admission to ICU, who made up 20% of the total 160 ICU patients. Mortality incidence was higher among patients with raised NLR. Vitamin C at the doses used did not affect the inflammatory parameters, length of stay or mortality, and 37.5% of the patients recovered and were discharged from the ICU.

Conclusions: We think that vitamin C treatment will have positive effects on the initiation of COVID-19 and that the time of intiation of the therapy and the optimal doses used should be determined with prospective studies.

References

  • 1. Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical presentation, and management of the pandemic coronavirus disease 2019 (COVID-19). Cureus 2020;12:e7560.
  • 2. Boretti A, Bimal KB. Intravenous vitamin C for reduction of cytokines storm in acute respiratory distress syndrome. PharmaNutrition 2020:100190.
  • 3. Zhao B, Ling Y, Li J, Peng Y, Huang J, Wang Y, et al. Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study. An Palliat Med 2021;10:1599-609.
  • 4. Moskowitz A, Huang DT, Hou PC, Gong J, Doshi PB, Grossestreuer AV, et al. Effect of ascorbic acid, corticosteroids, and thiamine on organ injury in septic shock: the ACTS randomized clinical trial. JAMA 2020;324:642-50.
  • 5. Cheng R. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Med Drug Discov 2020;5:100028.
  • 6. Zhang J, Xie B, Hashimoto K. Current status of potential therapeutic candidates for the COVID-19 crisis. Brain Behav Immun 2020;87:59-73.
  • 7. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017;356:i6583.
  • 8. Beigel JH, Nam HH, Adams PL, Krafft A, Ince WL, El-Kamary SS, et al. Advances in respiratory virus therapeutics a meeting report from the 6th isirv Antiviral Group conference. Antiviral Res 2019;167:45-67.
  • 9. Jayawardena R, Sooriyaarachchi P, Chourdakis M, Jeewandara C, Ranasinghe P. Enhancing immunity in viral infections, with special emphasis on COVID-19: a review, Diabetes Metab Syndr 2020;14:367-82.
  • 10. Adams KK, Baker WL, Sobieraj DM. Myth busters: dietary supplements and COVID-19. Ann Pharmacother 2020;54:820-6.
  • 11. Carr AC, Rosengrave PC, Bayer S, Chambers S, Mehrtens J, Shaw GM. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Crit Care 2017: 21:300.
  • 12. Hemilä H, Chalker E, Douglas B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2010:CD000980.
  • 13. Chen L, Liu HG, Liu W, Liu J, Liu K, Shang J, et al. [Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:203-8. [Article in Chinese]
  • 14. Fowler AA, Syed AA, Knowlson S. Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014;12: 32.
  • 15. Holford P, Carr AC, Jovic TH, Ali SR, Whitaker IS, Marik PE, et al. Vitamin C - an adjunctive therapy for respiratory infection, sepsis and COVID-19. Nutrients. 2020;12:3760.
  • 16. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci 2020;57:389-99.
  • 17. Wu R, Wang L, Kuo HD, Shannar A, Peter R, Chou PJ, et al. An update on current therapeutic drugs treating COVID-19. Curr Pharmacol Rep 2020;6:56-70.
  • 18. Michele CA, Angelo B, Valeria L, Teresa M, Pasquale DL, Giuseppe C, et al. Vitamin supplements in the Era of SARS-Cov2 pandemic. GSC Biol Pharm Sci 2020;11:7-19.
  • 19. Hemilä H, Chalker E. Vitamin C can shorten the length of stay in the ICU: a meta-analysis. Nutrients 2019;11:e708.
  • 20. Ozgunay SE, Eminoglu S. COVID-19 Tedavisinde Besin Destek Ürünleri Kullanımı Etkin ve Gerekli midir? Is the Use of Nutritional Supplements Effective and Necessary in the Treatment of COVID-19? COVID - 19 Pandemisi ve Anestezi. Türkiye Klinikleri. 2020; 1:108-114. online ISSBN: 978-625-401-091-0
  • 21. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (Sars-Cov-2 Enfeksiyonu) Ağır pnömoni, ARDS, sepsis ve septik şok yönetimi. bilimsel danışma kurulu çalışması. 1 haziran 2020, Ankara. Sayfa 13. https://covid19bilgi.saglik.gov.tr/depo/rehberler/covid-19-rehberi/COVID 19 rehberı genel bılgıler epıdemıyolojı_ve_tanı.pdf
  • 22. Arvinte C, Singh M, Marik PE. Serum levels of vitamin C and vitamin D in a cohort of critically ill COVID-19 patients of a north American community hospital intensive care unit in May 2020: a pilot study. Med Drug Discov 2020;8:100064.
  • 23. Kim SB, Huh K, Heo JY, Joo EJ, Kim YJ, Choi WS, et al. Interim guidelines on antiviral therapy for COVID-19. Infect Chemother 2020;52:281-304.
  • 24. Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Respir Res 2020;21:74.
  • 25. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020;84:106504.
  • 26. World Health Organization. Overview of the types/classes of candidate therapeutics - COVID-19. https://www.who.int/blueprint/priority-diseases/key-action/overview-ncov-therapeutics.pdf?ua=1. Landscape analysis of therapeutics as 21st March 2020
  • 27. Hemilä 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.
  • 28. Nabil-Habib T, Ahmed I. Early adjuvant intravenous vitamin C treatment in septic shock may resolve the vasopressor dependence. Int J Microbiol Adv Immunol 2017;5:77-81.
  • 29. Fowler AA, 3rd, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, et al. Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized Clinical trial. JAMA 2019;322:1261-70.
  • 30. Zhang J, Rao X, Li Y, Zhu Y, Liu F, Guo G, et al. High-dose vitamin C infusion for the treatment of critically ill COVID-19. Res Square 2020.
  • 31. Chiscano-Camón L, Ruiz-Rodriguez JC, Ruiz-Sanmartin A, Roca O, Ferrer R. Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome. Crit Care 2020;24:522.

Year 2021, Volume 7, Issue 4, 425 - 431, 04.07.2021
https://doi.org/10.18621/eurj.938778

Abstract

References

  • 1. Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical presentation, and management of the pandemic coronavirus disease 2019 (COVID-19). Cureus 2020;12:e7560.
  • 2. Boretti A, Bimal KB. Intravenous vitamin C for reduction of cytokines storm in acute respiratory distress syndrome. PharmaNutrition 2020:100190.
  • 3. Zhao B, Ling Y, Li J, Peng Y, Huang J, Wang Y, et al. Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study. An Palliat Med 2021;10:1599-609.
  • 4. Moskowitz A, Huang DT, Hou PC, Gong J, Doshi PB, Grossestreuer AV, et al. Effect of ascorbic acid, corticosteroids, and thiamine on organ injury in septic shock: the ACTS randomized clinical trial. JAMA 2020;324:642-50.
  • 5. Cheng R. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Med Drug Discov 2020;5:100028.
  • 6. Zhang J, Xie B, Hashimoto K. Current status of potential therapeutic candidates for the COVID-19 crisis. Brain Behav Immun 2020;87:59-73.
  • 7. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017;356:i6583.
  • 8. Beigel JH, Nam HH, Adams PL, Krafft A, Ince WL, El-Kamary SS, et al. Advances in respiratory virus therapeutics a meeting report from the 6th isirv Antiviral Group conference. Antiviral Res 2019;167:45-67.
  • 9. Jayawardena R, Sooriyaarachchi P, Chourdakis M, Jeewandara C, Ranasinghe P. Enhancing immunity in viral infections, with special emphasis on COVID-19: a review, Diabetes Metab Syndr 2020;14:367-82.
  • 10. Adams KK, Baker WL, Sobieraj DM. Myth busters: dietary supplements and COVID-19. Ann Pharmacother 2020;54:820-6.
  • 11. Carr AC, Rosengrave PC, Bayer S, Chambers S, Mehrtens J, Shaw GM. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Crit Care 2017: 21:300.
  • 12. Hemilä H, Chalker E, Douglas B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2010:CD000980.
  • 13. Chen L, Liu HG, Liu W, Liu J, Liu K, Shang J, et al. [Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:203-8. [Article in Chinese]
  • 14. Fowler AA, Syed AA, Knowlson S. Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014;12: 32.
  • 15. Holford P, Carr AC, Jovic TH, Ali SR, Whitaker IS, Marik PE, et al. Vitamin C - an adjunctive therapy for respiratory infection, sepsis and COVID-19. Nutrients. 2020;12:3760.
  • 16. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci 2020;57:389-99.
  • 17. Wu R, Wang L, Kuo HD, Shannar A, Peter R, Chou PJ, et al. An update on current therapeutic drugs treating COVID-19. Curr Pharmacol Rep 2020;6:56-70.
  • 18. Michele CA, Angelo B, Valeria L, Teresa M, Pasquale DL, Giuseppe C, et al. Vitamin supplements in the Era of SARS-Cov2 pandemic. GSC Biol Pharm Sci 2020;11:7-19.
  • 19. Hemilä H, Chalker E. Vitamin C can shorten the length of stay in the ICU: a meta-analysis. Nutrients 2019;11:e708.
  • 20. Ozgunay SE, Eminoglu S. COVID-19 Tedavisinde Besin Destek Ürünleri Kullanımı Etkin ve Gerekli midir? Is the Use of Nutritional Supplements Effective and Necessary in the Treatment of COVID-19? COVID - 19 Pandemisi ve Anestezi. Türkiye Klinikleri. 2020; 1:108-114. online ISSBN: 978-625-401-091-0
  • 21. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (Sars-Cov-2 Enfeksiyonu) Ağır pnömoni, ARDS, sepsis ve septik şok yönetimi. bilimsel danışma kurulu çalışması. 1 haziran 2020, Ankara. Sayfa 13. https://covid19bilgi.saglik.gov.tr/depo/rehberler/covid-19-rehberi/COVID 19 rehberı genel bılgıler epıdemıyolojı_ve_tanı.pdf
  • 22. Arvinte C, Singh M, Marik PE. Serum levels of vitamin C and vitamin D in a cohort of critically ill COVID-19 patients of a north American community hospital intensive care unit in May 2020: a pilot study. Med Drug Discov 2020;8:100064.
  • 23. Kim SB, Huh K, Heo JY, Joo EJ, Kim YJ, Choi WS, et al. Interim guidelines on antiviral therapy for COVID-19. Infect Chemother 2020;52:281-304.
  • 24. Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Respir Res 2020;21:74.
  • 25. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020;84:106504.
  • 26. World Health Organization. Overview of the types/classes of candidate therapeutics - COVID-19. https://www.who.int/blueprint/priority-diseases/key-action/overview-ncov-therapeutics.pdf?ua=1. Landscape analysis of therapeutics as 21st March 2020
  • 27. Hemilä 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.
  • 28. Nabil-Habib T, Ahmed I. Early adjuvant intravenous vitamin C treatment in septic shock may resolve the vasopressor dependence. Int J Microbiol Adv Immunol 2017;5:77-81.
  • 29. Fowler AA, 3rd, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, et al. Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized Clinical trial. JAMA 2019;322:1261-70.
  • 30. Zhang J, Rao X, Li Y, Zhu Y, Liu F, Guo G, et al. High-dose vitamin C infusion for the treatment of critically ill COVID-19. Res Square 2020.
  • 31. Chiscano-Camón L, Ruiz-Rodriguez JC, Ruiz-Sanmartin A, Roca O, Ferrer R. Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome. Crit Care 2020;24:522.

Details

Primary Language English
Subjects Critical Care Medicine
Journal Section Original Articles
Authors

Seyda Efsun OZGUNAY (Primary Author)
Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
0000-0003-1501-9292
Türkiye


İlkay CEYLAN
Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
0000-0003-3306-3107
Türkiye


Korgün ÖKMEN
Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
0000-0001-8546-4661
Türkiye


Halil Erkan SAYAN
Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
0000-0003-3943-5549
Türkiye


Şermin EMİNOGLU
Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
0000-0001-5741-2960
Türkiye


Derya KARASU
Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
0000-0003-1867-9018
Türkiye


Senol YAVUZ
Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
0000-0001-5246-0808
Türkiye

Publication Date July 4, 2021
Application Date May 18, 2021
Acceptance Date June 19, 2021
Published in Issue Year 2021, Volume 7, Issue 4

Cite

EndNote %0 The European Research Journal The use of vitamin C in the intensive care unit during the COVID-19 pandemic %A Seyda Efsun Ozgunay , İlkay Ceylan , Korgün Ökmen , Halil Erkan Sayan , Şermin Eminoglu , Derya Karasu , Senol Yavuz %T The use of vitamin C in the intensive care unit during the COVID-19 pandemic %D 2021 %J The European Research Journal %P -2149-3189 %V 7 %N 4 %R doi: 10.18621/eurj.938778 %U 10.18621/eurj.938778

e-ISSN: 2149-3189 


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