加拿大谢布鲁克大学François Lamontagne团队研究了重症监护病房脓毒症患者静脉注射维生素C对预后的影响。该研究于2022年6月15日发表在《新英格兰医学杂志》上。

在重症监护病房（ICU）接受血管升压药治疗的脓毒症成年人静脉注射维生素C的评估研究表明，在死亡风险和器官功能障碍方面的预后参差不齐。

在这项随机、安慰剂对照试验中，研究组将在ICU住院时间不超过24小时、已证实或主要诊断疑似感染、且正在接受血管升压药治疗的成年人，随机分配接受每6小时注射一次维生素C（剂量为每公斤体重50毫克）或匹配的安慰剂，持续96小时。主要结局为第28天死亡或持续性器官功能障碍（通过使用血管升压药、有创机械通气或新的肾脏替代疗法来定义）的综合结局。

共有872名患者接受了随机分组（维生素C组435名，对照组437名）。维生素C组429例患者中有191例（44.5%）发生主要结局，对照组434例患者中有167例（38.5%），风险比为1.21，差异显著。

28天时，维生素C组429名患者中有152名（35.4%）死亡，安慰剂组434名患者中有137名（31.6%），风险比为1.17；维生素C组429名患者中有39名（9.1%）发生持续性器官功能障碍，安慰剂组434名患者中有30名（6.9%），风险比为1.30。

两组患者在器官功能障碍评分、生物标志物、6个月生存率、健康相关生活质量、3期急性肾损伤和低血糖发作方面的结局相似。在维生素C组，有一名患者出现严重低血糖事件，另一名患者出现严重过敏事件。

研究结果表明，在ICU接受加压素治疗的脓毒症成人中，接受静脉注射维生素C的患者28天时的死亡风险或持续性器官功能障碍风险高于接受安慰剂的患者。

附：英文原文

Title: Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit | NEJM

Author: Franois Lamontagne, M.D.,, Marie-Hélène Masse, M.Sc.,, Julie Menard, Ph.D.,, Sheila Sprague, Ph.D.,, Ruxandra Pinto, Ph.D.,, Daren K. Heyland, M.D.,, Deborah J Cook, M.D.,, Marie-Claude Battista, Ph.D.,, Andrew G. Day, M.Sc.,, Gordon H. Guyatt, M.D.,, Salmaan Kanji, Pharm.D.,, Rachael Parke, R.N., M.H.Sc., Ph.D.,, Shay P. McGuinness, M.B., Ch.B.,, Bharath-Kumar Tirupakuzhi Vijayaraghavan, M.D.,, Djillali Annane, M.D., Ph.D.,, Dian Cohen, B.A.,, Yaseen M. Arabi, M.D.,, Brigitte Bolduc, M.Sc.,, Nicole Marinoff, R.N.,, Bram Rochwerg, M.D.,, Tina Millen, R.R.T.,, Maureen O. Meade, M.D.,, Lori Hand, B.Sc.,, Irene Watpool, R.N., B.Sc.N.,, Rebecca Porteous, B.N.Sc.,, Paul J. Young, M.B., Ch.B., Ph.D.,, Frederick D’Aragon, M.D.,, Emilie P. Belley-Cote, M.D., Ph.D.,, Elaine Carbonneau, R.N.,, France Clarke, R.R.T.,, David M. Maslove, M.D.,, Miranda Hunt, B.A.,, Michal Chassé, M.D., Ph.D.,, Martine Lebrasseur, R.N.,, Franois Lauzier, M.D.,, Sangeeta Mehta, M.D.,, Hector Quiroz-Martinez, M.D.,, Oleksa G. Rewa, M.D.,, Emmanuel Charbonney, M.D., Ph.D.,, Andrew J.E. Seely, M.D., Ph.D.,, Demetrios J. Kutsogiannis, M.D., M.H.S.,, Remi LeBlanc, M.D.,, Armand Mekontso-Dessap, M.D., Ph.D.,, Tina S. Mele, M.D., Ph.D.,, Alexis F. Turgeon, M.D.,, Gordon Wood, M.D.,, Sandeep S. Kohli, M.D.,, Jason Shahin, M.D.C.M.,, Pawel Twardowski, M.D., Ph.D.,, and Neill K.J. Adhikari, M.D.C.M.

Issue&Volume: 2022-06-15

Abstract:

Background

Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy in the intensive care unit (ICU) have shown mixed results with respect to the risk of death and organ dysfunction.

Methods

In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU for no longer than 24 hours, who had proven or suspected infection as the main diagnosis, and who were receiving a vasopressor to receive an infusion of either vitamin C (at a dose of 50 mg per kilogram of body weight) or matched placebo administered every 6 hours for up to 96 hours. The primary outcome was a composite of death or persistent organ dysfunction (defined by the use of vasopressors, invasive mechanical ventilation, or new renal-replacement therapy) on day 28.

Results

A total of 872 patients underwent randomization (435 to the vitamin C group and 437 to the control group). The primary outcome occurred in 191 of 429 patients (44.5%) in the vitamin C group and in 167 of 434 patients (38.5%) in the control group (risk ratio, 1.21; 95% confidence interval [CI], 1.04 to 1.40; P=0.01). At 28 days, death had occurred in 152 of 429 patients (35.4%) in the vitamin C group and in 137 of 434 patients (31.6%) in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40) and persistent organ dysfunction in 39 of 429 patients (9.1%) and 30 of 434 patients (6.9%), respectively (risk ratio, 1.30; 95% CI, 0.83 to 2.05). Findings were similar in the two groups regarding organ-dysfunction scores, biomarkers, 6-month survival, health-related quality of life, stage 3 acute kidney injury, and hypoglycemic episodes. In the vitamin C group, one patient had a severe hypoglycemic episode and another had a serious anaphylaxis event.

Conclusions

In adults with sepsis receiving vasopressor therapy in the ICU, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo.

DOI: 10.1056/NEJMoa2200644

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2200644