Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis
Evdokia Gavrielatou, Eleni Xourgia, Nikoleta A Xixi, Athina G Mantelou, Eleni Ischaki, Aggeliki Kanavou, Dimitris Zervakis, Christina Routsi, Anastasia Kotanidou, Ilias I Siempos
Frontiers in Medicine, doi:10.3389/fmed.2022.814587
of mortality among critically ill patients with COVID-19. Additional evidence is anticipated from relevant large randomized controlled trials which are currently underway.
AUTHOR CONTRIBUTIONS EG contributed to study design, collected data, and interpreted data. EX and NX contributed to study design and the execution of the meta-analysis and they wrote the first draft of the manuscript. EX also undertook statistical analyses. AM, EI, and AKa contributed to data collection. DZ contributed to study design and data interpretation. CR and AKo contributed to data interpretation and critically revised the manuscript. IS conceived of the study, designed the study, supervised the data collection and statistical analyses, and is the guarantor, and final responsibility for the decision to submit for publication. All authors read and approved the final manuscript.
SUPPLEMENTARY MATERIAL The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed. 2022.814587/full#supplementary-material
Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's Note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Copyright © 2022 Gavrielatou, Xourgia, Xixi, Mantelou,..
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'abstract': '<jats:sec><jats:title>Background</jats:title><jats:p>Whether vitamin C provides any benefit '
'when administered in critically ill patients, including those with coronavirus disease '
'(COVID-19), is controversial. We endeavored to estimate the effect of administration of '
'vitamin C on clinical outcomes of critically ill patients with COVID-19 by performing an '
'observational study and subsequent '
'meta-analysis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Firstly, '
'we conducted an observational study of critically ill patients with laboratory-confirmed '
'COVID-19 who consecutively underwent invasive mechanical ventilation in an academic intensive '
'care unit (ICU) during the second pandemic wave. We compared all-cause mortality of patients '
'receiving vitamin C (“vitamin C” group) or not (“control” group) on top of standard-of-care. '
'Subsequently, we systematically searched PubMed and CENTRAL for relevant studies, which '
'reported on all-cause mortality (primary outcome) and/or morbidity of critically ill patients '
'with COVID-19 receiving vitamin C or not treatment. Pooled risk ratio (RR) and 95% confidence '
'intervals (CI) were calculated using a random effects model. The meta-analysis was registered '
'with PROSPERO.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the '
'observational study, baseline characteristics were comparable between the two groups. '
'Mortality was 20.0% (2/10) in the vitamin C group vs. 47.6% (49/103; '
'<jats:italic>p</jats:italic> = 0.11) in the control group. Subsequently, the meta-analysis '
'included 11 studies (6 observational; five randomized controlled trials) enrolling 1,807 '
'critically ill patients with COVID-19. Mortality of patients receiving vitamin C on top of '
'standard-of-care was not lower than patients receiving standard-of-care alone (25.8 vs. '
'34.7%; RR 0.85, 95% CI 0.57–1.26; <jats:italic>p</jats:italic> = '
'0.42).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>After '
'combining results of our observational cohort with those of relevant studies into a '
'meta-analysis of data from 1,807 patients, we found that administration vitamin C as opposed '
'to standard-of-care alone might not be associated with lower of mortality among critically '
'ill patients with COVID-19. Additional evidence is anticipated from relevant large randomized '
'controlled trials which are currently '
'underway.</jats:p></jats:sec><jats:sec><jats:title>Systematic Review '
'Registration</jats:title><jats:p><jats:ext-link>https://www.crd.york.ac.uk/prospero/</jats:ext-link>, '
'identifier: CRD42021276655.</jats:p></jats:sec>',
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'author': 'Yanase',
'year': '2020',
'journal-title': 'Crit Care Med.'}],
'container-title': ['Frontiers in Medicine'],
'original-title': [],
'link': [ { 'URL': 'https://www.frontiersin.org/articles/10.3389/fmed.2022.814587/full',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2022, 2, 11]],
'date-time': '2022-02-11T05:57:35Z',
'timestamp': 1644559055000},
'score': 1,
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2022, 2, 11]]},
'references-count': 36,
'alternative-id': ['10.3389/fmed.2022.814587'],
'URL': 'http://dx.doi.org/10.3389/fmed.2022.814587',
'relation': {},
'ISSN': ['2296-858X'],
'issn-type': [{'value': '2296-858X', 'type': 'electronic'}],
'subject': ['General Medicine'],
'published': {'date-parts': [[2022, 2, 11]]}}
