Abstract: Chiscano-Camón et al. Critical Care
(2020) 24:522
https://doi.org/10.1186/s13054-020-03249-y
RESEARCH LETTER
Open Access
Vitamin C levels in patients with SARS-CoV2-associated acute respiratory distress
syndrome
Luis Chiscano-Camón1,2,3, Juan Carlos Ruiz-Rodriguez1,2,3*, Adolf Ruiz-Sanmartin1,2, Oriol Roca1,2,3,4 and
Ricard Ferrer1,2,3,4
Vitamin C is an antioxidant with anti-inflammatory and
immune-supportive properties. Its levels are decreased
in patients with sepsis-related acute respiratory distress
syndrome (ARDS). Moreover, a significant number of
patients with severe acute respiratory syndrome
coronavirus-2 (SARS-CoV-2) disease developed ARDS
[1]. Therefore, we hypothesized that ARDS coronavirus
disease 2019 (COVID-19) patients may present vitamin
C deficiency.
Plasma vitamin C levels in a population of adult
ICU patients COVID-19 who met ARDS criteria according to the Berlin definition [2] were prospectively
measured. The study was approved by the local
Clinical Research Ethics Committee (PR (AG)270/
2020). Main characteristics of the population included
are presented in Table 1. None of the patients included presented shock or sepsis on admission.
Equally, no bacterial co-infection during their ICU
course was documented. All patients survived. Vitamin C was determined by high-performance liquid
chromatography with photodiode detector (detection
limit 1.5 mg/L). Vitamin C reference values in general
population used to be above 5 mg/L. Seventeen patients (94.4%) had undetectable vitamin C levels and
1 patient had low levels (2.4 mg/L).
To our knowledge, this is the first study to analyze the
levels of vitamin C in patients with SARS-CoV-2-associated ARDS. Our study revealed that vitamin C levels are
undetectable in more than 90% of the patients included.
The mechanisms of this significant reduction in vitamin
C are uncertain. We hypothesized that several mechanisms, such as increased metabolic consumption due to
the enhanced inflammatory response, glomerular hyperfiltration, dialysis, decreased gastrointestinal absorption,
or decreased recycling of dehydroascorbate to ascorbic
acid, may be involved.
Moreover, vitamin C may have implications for treatment of COVID-19-associated ARDS [3]. Indeed, one
preclinical study showed that vitamin C increased resistance to infection caused by coronavirus [4]. Moreover,
other clinical studies that included surgical patients and
patients with pneumonia showed encouraging results in
terms of decreased incidence and severity of lung injury
and mortality [5].
* Correspondence: jcruiz@vhebron.net
1
Intensive Care Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron
Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, Barcelona 08035,
Spain
2
Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall
d’Hebron 119-129, Barcelona 08035, Spain
Full list of author information is available at the end of the article
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
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appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative..
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