Vitamin C and COVID-19
Harri Hemilä, Angelique M E De Man
Frontiers in Medicine, doi:10.3389/fmed.2020.559811
In numerous animal studies, vitamin C has prevented and alleviated viral and bacterial infections. In a few dozen placebo-controlled trials with humans, vitamin C has shortened infections caused by respiratory viruses, which indicates that the vitamin can also influence viral infections in humans. In critically ill patients, plasma vitamin C levels are commonly very low. Gram doses of vitamin C are needed to increase the plasma vitamin C levels of critically ill patients to the levels of ordinary healthy people. A meta-analysis of 12 trials with 1,766 patients calculated that vitamin C reduced the length of ICU stay on average by 8%. Another meta-analysis found that vitamin C shortened the duration of mechanical ventilation in ICU patients. Two randomized placebo-controlled trials found statistically significant reduction in the mortality of sepsis patients. The effects of vitamin C on acute respiratory distress syndrome (ARDS) frequently complicating COVID-19 pneumonia should be considered. Vitamin C is a safe and inexpensive essential nutrient.
AUTHOR CONTRIBUTIONS HH and AM participated in the revision of the manuscript.
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.
References
Arvinte, Singh, Marik, Serum levels of vitamin C and vitamin D in a cohort of critically ill COVID-19 patients of a north American community hospital intensive care unit in may 2020. A pilot study, Med Drug Discov,
doi:10.1016/j.medidd.2020.100064
Atherton, Kratzing, Fisher, The effect of ascorbic acid on infection of chick-embryo ciliated tracheal organ cultures by coronavirus, Arch Virol,
doi:10.1007/bf01317848
Carr, Rosengrave, Bayer, Chambers, Mehrtens et al., Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes, Crit Care,
doi:10.1186/s13054-017-1891-y
Carr, Rowe, The emerging role of vitamin C in the prevention and treatment of COVID-19, Nutrients,
doi:10.3390/nu12113286
Cerullo, Negro, Parimbelli, Pecoraro, Perna et al., The long history of vitamin C: from prevention of the common cold to potential aid in the treatment of COVID-19, Front Immunol,
doi:10.3389/fimmu.2020.574029
Chiscano-Camón, Ruiz-Rodriguez, Ruiz-Sanmartin, Roca, Ferrer, Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome, Crit Care,
doi:10.1186/s13054-020-03249-y
Fisher, Kraskauskas, Martin, Farkas, Wegelin et al., Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid, Am J Physiol Lung Cell Mol Physiol,
doi:10.1152/ajplung.00300.2011
Fisher, Seropian, Kraskauskas, Thakkar, Voelkel et al., Ascorbic acid attenuates lipopolysaccharide-induced acute lung injury, Crit Care Med,
doi:10.1097/CCM.0b013e3182120cb8
Fowler, Iii, Truwit, Hite, Morris et al., Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial, JAMA,
doi:10.1001/jama.2019.11825
Grooth, Manubulu-Choo, Zandvliet, Spoelstra-De Man, Girbes et al., Vitamin C pharmacokinetics in critically ill patients: a randomized trial of four iv regimens, Chest,
doi:10.1016/j.chest.2018.02.025
Hemilä, Chalker, Reanalysis of the effect of vitamin C on mortality in the CITRIS-ALI trial: important findings dismissed in the trial report, Front Med,
doi:10.3389/fmed.2020.590853
Hemilä, Chalker, Vitamin C can shorten the length of stay in the ICU: a meta-analysis, Nutrients,
doi:10.3390/nu11040708
Hemilä, Chalker, Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis, J Intensive Care,
doi:10.1186/s40560-020-0432-y
Hemilä, Do Vitamins C and E Affect Respiratory Infections?
Levine, Conry-Cantilena, Wang, Welch, Washko et al., Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance, Proc Natl Acad Sci,
doi:10.1073/pnas.93.8.3704
Li, Maeda, Beck, Vitamin C deficiency increases the lung pathology of influenza virus-infected gulo-/-mice, J Nutr,
doi:10.1093/jn/136.10.2611
Manning, Mitchell, Appadurai, Shakya, Pierce et al., Vitamin C promotes maturation of T-cells, Antioxid. Redox Signal,
doi:10.1089/ars.2012.4988
Zabet, Mohammadi, Ramezani, Khalili, Effect of high-dose ascorbic acid on vasopressor's requirement in septic shock, J Res Pharm Pract,
doi:10.4103/2279-042X.179569
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