Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit

被引：208

作者：

Lamontagne, Francois ^{[1
,4
,50
]}

Masse, Marie-Helene ^{[4
]}

Menard, Julie

Sprague, Sheila ^{[6
]}

Pinto, Ruxandra ^{[13
]}

Heyland, Daren K. ^{[8
,16
]}

Cook, Deborah J. ^{[7
,10
]}

Battista, Marie-Claude ^{[1
]}

Day, Andrew G. ^{[17
,19
]}

Guyatt, Gordon H. ^{[7
,8
]}

Kanji, Salmaan ^{[20
,21
,36
]}

Parke, Rachael ^{[37
,38
,39
,49
]}

McGuinness, Shay P. ^{[14
,15
]}

Vijayaraghavan, Bharath-Kumar Tirupakuzhi ^{[42
,43
]}

Annane, Djillali ^{[44
,45
,46
]}

Cohen, Dian ^{[5
,23
]}

Arabi, Yaseen M. ^{[48
]}

Bolduc, Brigitte ^{[3
]}

Marinoff, Nicole ^{[13
]}

Rochwerg, Bram ^{[7
,8
]}

Millen, Tina ^{[7
,11
]}

Meade, Maureen O. ^{[7
,8
]}

Hand, Lori ^{[8
,12
]}

Watpool, Irene ^{[21
]}

Porteous, Rebecca ^{[21
]}

Young, Paul J. ^{[39
,40
,49
]}

D'Aragon, Frederick ^{[2
,4
]}

Belley-Cote, Emilie P. ^{[7
,8
,9
]}

Carbonneau, Elaine ^{[4
,26
]}

Clarke, France ^{[8
]}

Maslove, David M. ^{[16
,18
,19
]}

Hunt, Miranda ^{[16
]}

Chasse, Michael ^{[24
,25
]}

Lebrasseur, Martine ^{[25
]}

Lauzier, Francois ^{[28
,29
,30
,31
]}

Mehta, Sangeeta ^{[37
,39
,49
]}

Quiroz-Martinez, Hector ^{[1
]}

Rewa, Oleksa G. ^{[32
]}

Charbonney, Emmanuel ^{[25
]}

Seely, Andrew J. E. ^{[22
]}

Kutsogiannis, Demetrios J. ^{[32
]}

LeBlanc, Remi ^{[33
]}

Mekontso-Dessap, Armand ^{[47
]}

Mele, Tina S. ^{[34
]}

Turgeon, Alexis F. ^{[29
,30
,31
]}

Wood, Gordon ^{[35
]}

Kohli, Sandeep S. ^{[7
]}

Shahin, Jason ^{[27
]}

Twardowski, Pawel ^{[41
]}

Adhikari, Neill K. J. ^{[13
,14
,51
]}

机构：

[1] Univ Sherbrooke, Dept Med, Sherbrooke, PQ, Canada

[2] Univ Sherbrooke, Dept Anesthesiol, Sherbrooke, PQ, Canada

[3] Ctr Hospitalier Univ Sherbrooke, Dept Pharm, Sherbrooke, PQ, Canada

[4] Ctr Hosp Univ Sherbrooke, Ctr Rech CHU Sherbrooke, Ctr Integre Univ, Serv Sociaux Estrie, Sherbrooke, PQ, Canada

[5] Bishops Univ, Sherbrooke, PQ, Canada

[6] Dept Surg, Div Orthopaed Surg, Hamilton, ON, Canada

[7] Dept Med, Hamilton, ON, Canada

[8] Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[9] Populat Hlth Res Inst, Hamilton, ON, Canada

[10] McMaster Univ, Dept Crit Care, St Josephs Healthcare Hamilton, Hamilton, ON, Canada

[11] Juravinski Hosp, Intens Care Unit, Hamilton, ON, Canada

[12] Resp Therapy, Hamilton Hlth Sci, Hamilton, ON, Canada

[13] Sunny Brook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada

[14] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[15] Sinai Hlth Syst, Toronto, ON, Canada

[16] Queens Univ, Dept Crit Care Med, Kingston, ON, Canada

[17] Queens Univ, Dept Publ Hlth Sci, Kingston, ON, Canada

[18] Queens Univ, Dept Med, Kingston, ON, Canada

[19] Kingston Hlth Sci Ctr, Kingston, ON, Canada

[20] Ottawa Hosp, Dept Pharm, Ottawa, ON, Canada

[21] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[22] Univ Ottawa, Dept Surg, Ottawa, ON, Canada

[23] Massawippi Valley Fdn, Ayers Cliff, PQ, Canada

[24] Univ Montreal, Dept Med, Montreal, PQ, Canada

[25] Ctr Hosp Univ Montreal, Montreal, PQ, Canada

[26] Hop Sacre Coeur Montreal, Ctr Rech, Montreal, PQ, Canada

[27] McGill Univ Hlth Ctr, Dept Med & Crit Care, Montreal, PQ, Canada

[28] CHU Quebec Univ Laval, Dept Med, Quebec City, PQ, Canada

[29] CHU Quebec Univ Laval, Dept Anesthesiol & Crit Care, Div Crit Care Med, Quebec City, PQ, Canada

[30] Univ Laval, Crit Care Med Serv, Quebec City, PQ, Canada

[31] Univ Laval, Res Ctr, Quebec City, PQ, Canada

[32] Univ Alberta, Dept Crit Care Med, Edmonton, AB, Canada

[33] CHU Dr Georges L Dumont, Dept Med, Div Intens Care, CHU Dr, Moncton, NB, Canada

[34] Western Univ, Schulich Sch Med & Dent, Dept Surg, London, ON, Canada

[35] Isl Hlth Author, Div Intens Care Med, Victoria, Romania

[36] Halton Healthcare, Dept Med, Oakville, ON, Canada

[37] Auckland City Hosp, Cardiothorac & Vasc Intens Care Unit, Auckland, New Zealand

[38] Univ Auckland, Sch Nursing, Auckland, New Zealand

[39] Med Res Inst New Zealand, Newtown, New Zealand

[40] Wellington Hosp, Intens Care Unit, Wellington, New Zealand

[41] Univ Otago, Dept Surg Sci, Dunedin, New Zealand

[42] Apollo Hosp, Dept Crit Care Med, Chennai, India

[43] George Inst Global Hlth, New Delhi, India

[44] Hop Raymond Poincare, Assistance Publ Hop Paris AP HP, Dept Intens Care Med, Raymond, France

[45] Federat Hosp Univ SEPSIS, Garches, France

[46] Univ Paris Saclay Campus UVSQ, Inst Natl St & Rech Med, Versailles, France

[47] Univ Paris Est Creteil, Hop Univ Henri Mondor, APHP, Inst Mondor Rech Biomed,Serv Med Intens Reani, Creteil, France

[48] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Med, King Abdullah Int Med Res Ctr, Dept Intens Care, Riyadh, Saudi Arabia

[49] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia

[50] Univ Sherbrooke, Dept Med, 3001 12th Ave N, Sherbrooke, PQ J1H 5N4, Canada

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2022年 / 386卷 / 25期

关键词：

COMPOSITE END-POINTS; RANDOMIZED-TRIAL; ORGAN FAILURE; SEPTIC SHOCK;

D O I：

10.1056/NEJMoa2200644

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (Funded by the Lotte and John Hecht Memorial Foundation; LOVIT ClinicalTrials.gov number, NCT03680274.)

引用

页码：2387 / 2398

页数：12

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