Role of Vitamin C in Outcome of Patients with Sepsis in Intensive Care Unit: An Observational Study

INTRODUCTION: Sepsis is a life-threatening organ dysfunction caused by a dysregulated patient response to infection. It is a life-threatening condition that arises when the body's response to infection causes injury to itself and its organs. Vitamin C is an essential micronutrient and has a number of biological functions in human body. With respect to disease treatment, there is evidence of benefit from Vitamin C to various extents through various mechanisms in a number of diseases - Heart failure, Hypertension, Diabetes Mellitus, multiple cancers, common cold, asthma and lead toxicity to name a few. Thus, Vitamin C, through its various biological functions and actions on multiple biological pathways, has preventive and curative role in multiple conditions.(1) OBJECTIVES: To evaluate the effectiveness of high dose intravenous ascorbic acid in patients with Sepsis admitted in Critical Care Unit for mortality in adult patients, organ dysfunction (as indicated by SOFA score) and length of stay. MATERIALS AND METHODS: This observational cross-sectional study was conducted in critical care unit of JK Hospital and LN Medical College, Bhopal, over six months. It included 104 critically ill patients with evidence of sepsis aged ≥15 years. Total of 104 patients diagnosed with Sepsis were taken and divided into 2 groups Standard Therapy (ST) and Ascorbic Acid (AA). Both the groups were given standard therapy for sepsis along with IV Ascorbic Acid to group AA. The outcome was assessed based on mortality, organ dysfunction (SOFA) and length of ICU stay. RESULTS: After admission to the ICU, the SOFA score increased among the participants given standard treatment. In contrast, the SOFA score gradually decreased between 1”- and 4”- days after the admission to ICU among the participants given ascorbic acid. The mean ICU stay among participants in the Standard Therapy (ST) and Ascorbic Acid (AA) groups was 9 and 8 days, respectively. Not all therapies are meant to save lives, some are meant to reduce complications, amount of damage to organs, facilitate early recovery or improve quality of life.(2–4) DISCUSSIONS/CONCLUSIONS: An antioxidant is any substance that prevents oxidative damage to a target molecule. Ascorbic acid is vital for several biological pathways, including its role as an electron donor to a few enzymes. It is thought to be important in the prevention of diseases associated with the phenomenon of oxidative stress whereby reactive oxygen species or free radicals build up as a by-product of physiological or pathophysiological processes. Evidence showed that inadequate intake of micronutrients, including vitamin C, decreases resistance to infection and increases disease complications. Administration of vitamin C in high oral doses (60 mg/kg) enhanced natural killer cell activity, which plays an important role in the innate immunity against viral infection. In addition, vitamin C might have an anti-apoptotic effect on peripheral blood neutrophils. Therefore, the author conducted this study to observe the outcome of high dose ascorbic acid administration on the clinical outcome among patients admitted to the intensive care unit with sepsis and compare it with outcomes among patients given standard therapy for sepsis.