A systematic review on the role of high-dose vitamin C in trauma patients

Major trauma and polytrauma are leading causes of mortality, driven by haemorrhagic shock and a dysregulated inflammatory response. Vitamin C, which has a role in vasopressor synthesis, endothelial function and antioxidant defence, is rapidly depleted in critical illness. Vitamin C has been highlighted as a promising therapeutic opportunity in trauma patients. This systematic review evaluates the evidence of vitamin C use in adult trauma patients.

The systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) and is reported according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Embase, Medline, CINAHL, SCOPUS, ClinicalTrials.gov, and Cochrane Central were searched up to December 2025. Studies evaluating intravenous vitamin C in adult trauma patients were included, with studies screened and quality assessed in duplicate by two blinded authors. Meta-analysis was not possible due to heterogeneous outcome reporting.

Six studies, including three randomised controlled trials (RCTs) and three cohort studies, met the inclusion criteria. The included studies suggest patients receiving high-dose vitamin C may have a significantly lower mortality with significantly reduced intensive care unit and hospital stays. There were also lower rates of sepsis and organ failure in the vitamin C cohorts. These findings derive from a small number of methodologically heterogeneous studies, resulting in a limited certainty of evidence.

This review identifies the potential benefit of intravenous high-dose vitamin C in trauma patients, supported by a strong biological rationale. The studies included are heterogeneous, which limits their strength and results in low certainty of our presented evidence. High-quality, adequately powered RCTs with standardised protocols, including dosing regimen and timing, are needed before routine clinical use can be recommended.