1.
Unusual Early Recovery of a Critical COVID-19 Patient After Administration of Intravenous Vitamin C.
Waqas Khan, HM, Parikh, N, Megala, SM, Predeteanu, GS
The American journal of case reports. 2020;21:e925521
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Coronavirus disease (Covid-19) continues to spread globally and to date there are no proven treatments. Current treatment focuses on the management of the associated acute respiratory distress syndrome (ARDS). There are many studies demonstrating that in severe sepsis and ARDS; Vitamin C reduces systemic inflammation, prevents lung damage, reduces the duration of mechanical ventilation (MV) and the length of intensive care unit (ICU) stay in patients. This is a case report where a critically ill patient received high-dose Vitamin C intravenous (IV) infusions and recovered. A 74 year-old woman with Covid-19, developed ARDS and septic shock. Usual medications were given. She needed MV and deteriorated rapidly. On Day 7 she was administered Vitamin C (11g per 24 hours as a continuous IV infusion). Her clinical condition improved slowly after this. In this case, high dose IV Vitamin C was associated with fewer days on mechanical intervention, a shorter ICU stay and earlier recovery. These results show the importance of further investigation of IV Vitamin C to assess its efficacy in critically ill Covid-19 patients requiring mechanical ventilation and ICU care.
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) continues to spread, with confirmed cases now in more than 200 countries. Thus far there are no proven therapeutic options to treat COVID-19. We report a case of COVID-19 with acute respiratory distress syndrome who was treated with high-dose vitamin C infusion and was the first case to have early recovery from the disease at our institute. CASE REPORT A 74-year-old woman with no recent sick contacts or travel history presented with fever, cough, and shortness of breath. Her vital signs were normal except for oxygen saturation of 87% and bilateral rhonchi on lung auscultation. Chest radiography revealed air space opacity in the right upper lobe, suspicious for pneumonia. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus-2 came back positive while the patient was in the airborne-isolation unit. Laboratory data showed lymphopenia and elevated lactate dehydrogenase, ferritin, and interleukin-6. The patient was initially started on oral hydroxychloroquine and azithromycin. On day 6, she developed ARDS and septic shock, for which mechanical ventilation and pressor support were started, along with infusion of high-dose intravenous vitamin C. The patient improved clinically and was able to be taken off mechanical ventilation within 5 days. CONCLUSIONS This report highlights the potential benefits of high-dose intravenous vitamin C in critically ill COVID-19 patients in terms of rapid recovery and shortened length of mechanical ventilation and ICU stay. Further studies will elaborate on the efficacy of intravenous vitamin C in critically ill COVID-19.
2.
Reanalysis of the Effect of Vitamin C on Mortality in the CITRIS-ALI Trial: Important Findings Dismissed in the Trial Report.
Hemilä, H, Chalker, E
Frontiers in medicine. 2020;7:590853
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This article is a re-analysis of data from a clinical trial into the effects of intravenous vitamin C on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure. The authors of this critique argue that the way the results were presented in the original paper is misleading. In particular, they criticise the focus on biomarkers, rather than important clinical outcomes. Apparently, whilst many of the biomarkers showed no significant improvements, vitamin C significantly improved three out of four clinically important outcomes: ICU-free days, hospital-free days, and mortality, but not ventilator-free days. The authors also point out a number of flaws in study design, for example, mortality follow-up was 28 days although vitamin C was only given for four days, and apparently data showed significantly better outcomes whilst patients received vitamin C. Overall, the authors of this critique conclude that the effect of vitamin C on mortality in this study is not equal to placebo as suggested by the authors of the original paper, but that vitamin C causes an 81% reduction in mortality which is similar to that shown in other clinical studies.
3.
Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis.
Hemilä, H, Chalker, E
Journal of intensive care. 2020;8:15
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Whilst 100mg vitamin C per day may be sufficient to maintain normal plasma vitamin C levels in healthy people, critically ill patients appear to have a much greater need for vitamin C. A previous meta-analysis showed that vitamin C supplementation shortened the stay in intensive care units (ICU) by 7.8% and duration of mechanical ventilation by 18%. The extent to which vitamin C shortened need for ventilation varied greatly between studies and appeared to depend on duration of ventilation in the control group which reflects the severity of illness in the study population. The aim of this study was to confirm this theory by analysing the relationship between the effect of vitamin C in the treatment group and the duration of mechanical ventilation in the control group, as a proxy for the severity of the disease. Nine trials with 975 patients overall were included in the analysis. Vitamin C was administered either orally or intravenously and dosages ranged between 1-6g per day for all but one trial which used 90g per day. Severity of illness at baseline varied greatly between studies, with a 250-fold variation of length of mechanical ventilation. The analysis confirmed that when duration of ventilation was less than 10 hours there was no meaningful benefit from vitamin C whilst there was a 31% decrease in duration of mechanical ventilation when durations were longer than 100 hours, reflecting the severity of the illnesses included in the studies. The study with the highest dose of vitamin C saw the largest effects but the authors attributed this to the fact that this study had the sickest patient population rather than to the high dose of vitamin C.
Abstract
BACKGROUND Our recent meta-analysis indicated that vitamin C may shorten the length of ICU stay and the duration of mechanical ventilation. Here we analyze modification of the vitamin C effect on ventilation time, by the control group ventilation time (which we used as a proxy for severity of disease in the patients of each trial). METHODS We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and reference lists of relevant publications. We included controlled trials in which the administration of vitamin C was the only difference between the study groups. We did not limit our search to randomized trials and did not require placebo control. We included all doses and all durations of vitamin C administration. One author extracted study characteristics and outcomes from the trial reports and entered the data in a spreadsheet. Both authors checked the data entered against the original reports. We used meta-regression to examine whether the vitamin C effect on ventilation time depends on the duration of ventilation in the control group. RESULTS We identified nine potentially eligible trials, eight of which were included in the meta-analysis. We pooled the results of the eight trials, including 685 patients in total, and found that vitamin C shortened the length of mechanical ventilation on average by 14% (P = 0.00001). However, there was significant heterogeneity in the effect of vitamin C between the trials. Heterogeneity was fully explained by the ventilation time in the untreated control group. Vitamin C was most beneficial for patients with the longest ventilation, corresponding to the most severely ill patients. In five trials including 471 patients requiring ventilation for over 10 h, a dosage of 1-6 g/day of vitamin C shortened ventilation time on average by 25% (P < 0.0001). CONCLUSIONS We found strong evidence that vitamin C shortens the duration of mechanical ventilation, but the magnitude of the effect seems to depend on the duration of ventilation in the untreated control group. The level of baseline illness severity should be considered in further research. Different doses should be compared directly in future trials.
4.
Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome.
Chiscano-Camón, L, Ruiz-Rodriguez, JC, Ruiz-Sanmartin, A, Roca, O, Ferrer, R
Critical care (London, England). 2020;24(1):522
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Sepsis related acute respiratory disease (ARDS) is associated with Covid-19. ARDS patients can present with decreased levels of vitamin C and so by association Covid-19 patients may also have low vitamin C levels. In this cohort study, 18 Covid-19 ARDS patients of which all survived were assessed for vitamin C levels. 17 patients had undetectable levels of vitamin C and one had low levels. It was concluded that more than 90% of the patients in this study had undetectable levels of vitamin C, which may be due to several reasons, such as reduced absorption of vitamin C in the gut and decreased production. Clinicians could use this study to understand the importance of monitoring vitamin C levels in patients with Covid-19.
5.
Extra Dose of Vitamin C Based on a Daily Supplementation Shortens the Common Cold: A Meta-Analysis of 9 Randomized Controlled Trials.
Ran, L, Zhao, W, Wang, J, Wang, H, Zhao, Y, Tseng, Y, Bu, H
BioMed research international. 2018;2018:1837634
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The common cold poses a heavy burden worldwide, in terms of human health and economic losses. The aim of this meta-analysis was to evaluate whether vitamin C could be used for relieving symptoms, shortening the duration, or reducing the incidence of the common cold. Nine randomised controlled trials conducted between 1950 and 2001 were included in the meta-analysis. No statistically significant effects were found when vitamin C was only started at the onset of symptoms, but regular supplementation with therapeutic doses of vitamin C at the onset of illness shortened the duration of the common cold and the time confined indoors, and relieved the symptoms, including chest pain, fever and chills. Based on this meta-analysis the authors recommend a small daily dose of vitamin C (no more than 1.0g/day) to support immunity and a larger dose of vitamin C during the common cold (a larger dose than before, usually 3.0 g/day to 4.0 g/day) to better recover health.
Abstract
AIM: To investigate whether vitamin C is effective in the treatment of the common cold. METHOD After systematically searching the National Library of Medicine (PubMed), Cochrane Library, Elsevier, China National Knowledge Infrastructure (CNKI), VIP databases, and WANFANG databases, 9 randomized placebo-controlled trials were included in our meta-analysis in RevMan 5.3 software, all of which were in English. RESULTS In the evaluation of vitamin C, administration of extra therapeutic doses at the onset of cold despite routine supplementation was found to help reduce its duration (mean difference (MD) = -0.56, 95% confidence interval (CI) [-1.03, -0.10], and P = 0.02), shorten the time of confinement indoors (MD = -0.41, 95% CI [-0.62, -0.19], and P = 0.0002), and relieve the symptoms associated with it, including chest pain (MD = -0.40, 95% CI [-0.77, -0.03], and P = 0.03), fever (MD = -0.45, 95% CI [-0.78, -0.11], and P = 0.009), and chills (MD = -0.36, 95% CI [-0.65, -0.07], and P = 0.01). CONCLUSIONS Extra doses of vitamin C could benefit some patients who contract the common cold despite taking daily vitamin C supplements.
6.
Vitamin C and Infections.
Hemilä, H
Nutrients. 2017;9(4)
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This article reviews the available literature on the effect of vitamin C on infections. In the early 20th century scurvy was found to be due to vitamin C deficiency and it was also observed that lack of vitamin C predisposed to infections, in particular pneumonia, which sparked interest in the connection between vitamin C and infections. Infections increase oxidative stress which may lead to a decrease in plasma levels of vitamin C, which has antioxidant properties, and much higher intakes of vitamin C may be necessary to maintain sufficiently high plasma levels during an infection. In animal studies vitamin C has been found to be beneficial against various infectious agents including bacteria, viruses, Candida albicans, and protozoa. The common cold is the most widely studied infection with regards to vitamin C. Vitamin C supplementation has been shown to only decrease the incidence of the common cold in specific subgroups but not the population as a whole. However, supplementing no less than 1g vitamin C per day significantly shortened the duration and alleviated severity of colds. Interpretation of studies is complicated by a number of factors, including dose of vitamin C, with up to a 240-fold difference between the lowest and highest vitamin C supplementary dose used in the common cold trials. This review also discusses why interest in the vitamin C/common cold research plummeted in the mid-1970s. Studies on vitamin C and pneumonia showed benefits, but as all these trials were done in specific population groups, the results cannot necessarily be generalised. There is insufficient clinical research into the use of vitamin C for other infections. The author concludes that in view of vitamin C being safe and cheap even modest clinical effects are worth exploring.
Abstract
In the early literature, vitamin C deficiency was associated with pneumonia. After its identification, a number of studies investigated the effects of vitamin C on diverse infections. A total of 148 animal studies indicated that vitamin C may alleviate or prevent infections caused by bacteria, viruses, and protozoa. The most extensively studied human infection is the common cold. Vitamin C administration does not decrease the average incidence of colds in the general population, yet it halved the number of colds in physically active people. Regularly administered vitamin C has shortened the duration of colds, indicating a biological effect. However, the role of vitamin C in common cold treatment is unclear. Two controlled trials found a statistically significant dose-response, for the duration of common cold symptoms, with up to 6-8 g/day of vitamin C. Thus, the negative findings of some therapeutic common cold studies might be explained by the low doses of 3-4 g/day of vitamin C. Three controlled trials found that vitamin C prevented pneumonia. Two controlled trials found a treatment benefit of vitamin C for pneumonia patients. One controlled trial reported treatment benefits for tetanus patients. The effects of vitamin C against infections should be investigated further.