The effects of vitamin C supplementation in the critically ill patients outcomes: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Vitamin C has significant anti-inflammatory effects and is particularly important for critically ill patients. However due to inconsistent research findings in critically ill patients in meta-analysis. Therefore, the primary objective of this meta-analysis is to investigate the effects of isolated intravenous supplementation of vitamin C in adults with critical illness by comprehensively incorporating articles from randomized controlled trials. Methods: Articles included searching through PubMed, Embase, Medline, Cochrane Library, and Web of Science up to April 28, 2023, for articles on vitamin C and the critically ill. We calculated pooled standard relative risk (RR), mean difference (MD), and 95% confidence intervals (CIs). And the protocol for the review has been registered on PROSPERO (CRD42023425193). Results: There are 2047 critically ill included in 19 articles. Compared with placebo, patients who underwent intravenous vitamin C (IVVC) have reduced duration of vasopressor used (SMD 0.26; CI 0.01–0.51; I 2 = 87.0%, P = .044), mechanical ventilation (SMD −0.29; CI −0.55 to −0.03; I 2 = 36.8%, P = .031). However, the administration of IVVC had no statistical difference in 28-d mortality (RR 0.95; CI 0.80–1.11; I 2 = 12.2%, P = .337), mortality (RR 0.79; CI 0.55–1.12; I 2 = 0%, P = .188), fluid intake (SMD −0.02; CI −0.25 to 0.20; I 2 = 0%, P = .838), urine output (SMD 0.23; CI −0.03 to 0.49; I 2 = 0%, P = .084), ICU days (SMD 0.10; CI −0.03 to 0.22; I 2 = 0%, P = .127), hospital stay (SMD 0.10; CI −0.12 to 0.32; I 2 = 0%, P = .375), and pneumonia (RR 0.85; CI 0.50–1.44; I 2 = 0%, P = .552). Conclusion: This study comprehensively and systematically evaluated IVVC supplementation in the critically ill through a meta-analysis of RCT. There is no difference except for patients who had reduced duration of vasopressor use and mechanical ventilation by the administration of IVVC. Of course. More scientific and rigorous conclusions can be drawn from multi-center RCT research in the future.