High-dose intravenous vitamin C attenuates hyperinflammation in severe coronavirus disease 2019
Guozhi Xia, Di Fan, Yanru He, Yaohu Zhu, Ph.D Qiangsun Zheng
Nutrition, doi:10.1016/j.nut.2021.111405
High-dose intravenous vitamin C (HIVC) is a major concern when treating patients with coronavirus disease 2019 . The aim of this study was to assess the clinical efficacy of HIVC on hyperinflammation in patients with severe COVID-19. Methods: This retrospective cohort study included hospitalized patients with severe COVID-19, a subset of whom was treated with HIVC. The medical records were screened for demographic data, laboratory findings, and medications, as well as initial and repeated values of multiple inflammatory markers for analysis. Results: A high percentage of patients presented with hyperinflammation based on inflammatory marker levels above the upper limit of normal (high-sensitivity C-reactive protein, 80.1%; interleukin-6, 91.5%; and tumor necrosis factor-a, 67.4%). Eighty-five (36%) patients received HIVC therapy. After treatment with HIVC, the levels of inflammatory markers displayed a significant decrease compared with those of patients without HIVC. Furthermore, the percentages of reduction in inflammatory marker levels were higher in patients receiving HIVC compared with those in patients treated without HIVC. Stepwise multiple linear regression analysis revealed that HIVC was independently associated with percentages of reduction in levels of inflammatory markers. Conclusions: HIVC has the potential benefit of attenuating hyperinflammation by reducing inflammatory marker levels in patients with severe COVID-19.
References
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
Carr, Rowe, The emerging role of vitamin C in the prevention and treatment of COVID-19, Nutrients
Channappanavar, Perlman, Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology, Semin Immunopathol
Chen, Luo, Yuan, Wang, Yang et al., Vitamin C mitigates oxidative stress and tumor necrosis factor-alpha in severe community-acquired pneumonia and LPS-induced macrophages, Mediators Inflamm
Du, Yuan, Sun, Tang, Cheng et al., Therapeutic efficacy of high-dose vitamin C on acute pancreatitis and its potential mechanisms, World J Gastroenterol
Fowler 3rd, Syed, Knowlson, Sculthorpe, Farthing et al., Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis, J Transl Med
Fowler Aa 3rd, Kim, Lepler, Malhotra, Debesa et al., Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute respiratory distress syndrome, World J Crit Care Med
Fowler Aa 3rd, Truwit, Hite, Morris, Dewilde 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
Gao, Xu, Wang, Lv, Ma et al., The efficiency and safety of highdose vitamin C in patients with COVID-19: a retrospective cohort study, Aging
Gerlach, Gerlach, Markers of hyperinflammation, Minerva Anestesiol
H€ Artel, Strunk, Bucsky, Schultz, Effects of vitamin C on intracytoplasmic cytokine production in human whole blood monocytes and lymphocytes, Cytokine
Lau, Lau, Chan, Li, Chen et al., Delayed induction of proinflammatory cytokines and suppression of innate antiviral response by the novel Middle East respiratory syndrome coronavirus: implications for pathogenesis and treatment, J Gen Virol
Li, Geng, Peng, Meng, Lu, Molecular immune pathogenesis and diagnosis of COVID-19, J Pharm Anal
Lipworth, Chan, Lipworth, Kuo, Weathering the cytokine storm in susceptible patients with severe SARS-CoV-2 infection, J Allergy Clin Immunol Pract
Mehta, Mcauley, Brown, Sanchez, Tattersall et al., COVID-19: consider cytokine storm syndromes and immunosuppression, Lancet
Moore, June, Cytokine release syndrome in severe COVID-19, Science
Mousavi, Bereswill, Heimesaat, Immunomodulatory and antimicrobial effects of vitamin C, Eur J Microbiol Immunol
Wiersinga, Rhodes, Cheng, Peacock, Prescott, Pathophsiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review, JAMA
Xia, Ma, He, Wang, Zhu, Hyper-inflammatory response involves in cardiac injury among patients with coronavirus disease
Zhang, Rao, Li, Zhu, Liu et al., Pilot trial of high-dose vitamin C in critically ill COVID-19 patients, Ann Intensive Care
