Effects of High Dose Vitamin C

Supplementation on Severe COVID-19

Patients In The ICU: A Retrospective Analysis

Department of Medicine, Hospital Raja Permaisuri Bainun, Ipoh (HRPB)1; Department of Anaesthesiology and Intensive Care, HRPB2;Clinical Research Centre (CRC), HRPB3;

Department of Obstetrics and Gynaecology, Mahkota Medical Centre, Melaka 4; Department of Medicine, Hospital Kuala Lumpur (HKL)5; CRC, HKL6

C-46

NMRR NO: NMRR-20-684-54478

CKW Wong1, G.R. Letchuman1, KW Foong2, HB Ker1, CL Lim1, BH Lee1, EL Leong3,

XJ Lim3, S. Vijaendreh4, CL Leong5, Nadiah Ismail6

Introduction

Approximately 14% of confirmed cases developed severe disease which involves acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The triggering factor is a cytokine storm that causes overwhelming oxidative stress which results in severe lung tissue damage. High dose ascorbic acid (Vitamin C) being an antioxidant that may have the propensity to mitigate such severe oxidative stress in an effort to keep lung injury minimal besides preventing other organ failures.

Methodology

This is a retrospective matched analysis of critically ill COVID-19 patients treated with high dose Vitamin C against those without in two different tertiary hospitals.

63 687 (1, 10) 9 (4, 10)

Median Age

Conclusion

There is a signal towards the utility of high dose Vitamin C as an adjunct in the therapy armamentarium of severe COVID-19 infection in terms of improved mortality and shorter duration of mechanical ventilation.

A future prospective randomized controlled trial will be beneficial to investigate this link besides looking at the other organ failure parameters apart from the lung.

HYPERTENSION

CKD

14.3%

0.0%

14.3%

DM

71.4%

71.4%

71.4%

57.4%

OTHERS

14.3%

57.4%

SMOKER 14.3%42.9%

Comorbidities

IHD42.9%

Covid-19 Related Medications Usage

100%

100%

100%

100%

100%57.1%

85.7%

71.4%

28.6%

100%

71.4%

57.1%

85.7%

HYDROXYCHLOROQUINE

INTERFERON 1b

KALETRA

OSELTAMIVIR

HEPARIN

HYDROCORTISONE

VITAMIN C 0%

Results

Both cohorts showed very similar clinical background, comorbids, illness severity, and severity score on admission.

The mortality rate differed in which the Vitamin C cohort stands at 14.3% while the Non Vitamin C at 71.4%. Clinical improvement in the Vitamin C group was also reflected by the median change of SOFA score when the disease progressed (0.5 vs 6).

All patients were on oxygen support in which 12 out of the 14 were on ventilator support. Amongst the patients who survived until extubation, days on the ventilator were shorter in the Vitamin C group compared to non Vitamin C (14 vs 19.6 days). When looking at duration to complete weaning of oxygen therapy, it was also shorter in Vitamin C group (16 vs 23.5 days).

Discussion

The results above show that there is some signal in which high dose Vitamin C may be beneficial in patients with severe COVID-19 infection. Pertaining to previous studies done on the COVID-19 cohort, many studies have shown high dose vitamin C usage results in improvement in respiratory function and clinical outcome of Covid-19 patients.

Vitamin C levels in the body may deplete with infection and high doses are needed to replenish the stores as well as provide extra in the face of such stresses.

5 (4, 14) 7 (5, 13)SOFA

Days of illness upon

admission, Median (IQR)

Stage of Illness

4

4

5

5 55

5

Stage of Illness

4

4

5

5 55

5

Baseline

Vitamin C

Group

Non

Vitamin

C GroupCovid-19

patient, without Vitamin C

COVID-19 treated with Vitamin C, n=7

Non Vitamin C Group, n=7

Data Collection

Analysis

Inhibit TNF-α production and in turn, retard the acute hyperinflammatory response.

Assists lung epithelial cell recovery and surfactant production to improve lung

function and mechanics.

Protect the tissues from oxidative damage and dysfunction.

References

I. Erol, A. (2020). High-dose intravenous vitamin C treatment for COVID-19.

II. Carr, A. C. (2020). A new clinical trial to test high-dose vitamin C in patients with COVID-19.

III. Wang, L. S., et al. (2020). A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence.

IV. Matthay, M. A., et al. (2020). Treatment for severe acute respiratory distress syndrome from COVID-19.

V. Hiedra, R., et al. (2020). The Use of IV vitamin C for patients with COVID-19: a single center observational study.

VI. Truwit, J. D., et al. (2019). The CITRIS-ALI randomized clinical trial.

57%Discharged

well

71%Death

14%

57% lower in Mortality rate

9 days shorter for Hospital Stay

5.6 days faster in Successful Extubation

7.5 days faster in Weaning off Oxygen Support

Result favors Vitamin C group

Result

29%Discharged with disabilities

29%

Acknowledgement

We would like to acknowledge the Director General of Health, Dr Sharon L Lojikip, SN Wan Rugayah (HKL), Dr Leong Chin Tho, Dato Dr Ong Loke Meng, CRC Penang Team and COVID Team HRPB for their contributions towards the success of this study.