Vitamin C for Sepsis and Septic Shock

Area of Science:

• Critical care medicine
• Pharmacology
• Biochemistry

Background:

• Sepsis is a major cause of mortality in critically ill patients.
• The combination of thiamine, vitamin C, and hydrocortisone (HAT) is being investigated as supportive care for sepsis and septic shock.
• Existing research presents varied findings, fueling debate on vitamin C's clinical utility in sepsis.

Purpose of the Study:

• To review the current literature on the efficacy and safety of vitamin C, with or without thiamine and hydrocortisone, as adjunctive therapy for sepsis and septic shock.
• To identify limitations and areas of uncertainty in existing studies.
• To summarize key findings regarding vitamin C's role in sepsis management.

Main Methods:

• A comprehensive literature search of PubMed and Embase databases was conducted up to April 2021.
• Included studies encompassed controlled trials, observational studies, reviews, guidelines, and consensus statements.
• Systematic evaluation of study bias and narrative summarization of clinical data on efficacy and safety were performed.

Main Results:

• The common dosage for vitamin C in sepsis is 1.5 g every 6 hours, often combined with thiamine and hydrocortisone.
• Literature is limited by heterogeneity in vitamin C regimens, timing, and duration, leading to variable outcomes.
• Vitamin C appears safe and may reduce proinflammatory mediators and slow endothelial injury, but outcomes like mortality and organ failure resolution show inconsistencies between study types.

Conclusions:

• Further research with standardized protocols, consistent endpoints, and early initiation is crucial.
• Standardized vitamin C dosing regimens are needed to clarify its overall benefit in sepsis treatment.
• Consistent study designs are required to resolve the debate on vitamin C's role in sepsis and septic shock management.