Vitamin C has potential protective effects through antioxidant and anti-inflammatory properties. However, the effect of vitamin C supplementation on microvascular function and peripheral tissue perfusion in human sepsis remains unknown. We aimed to determine vitamin C effect on microvascular endothelial dysfunction and peripheral tissue perfusion in septic shock patients. Patients with septic shock were prospectively included after initial resuscitation. Bedside peripheral tissue perfusion and skin microvascular reactivity in response to acetylcholine iontophoresis in the forearm area were measured before and 1 h after intravenous vitamin C supplementation (40 mg/kg). Norepinephrine dose was not modified during the studied period. We included 30 patients with septic shock. SOFA score was 11 [8–14], SAPS II was 66 [54–79], and in-hospital mortality was 33%. Half of these patients had vitamin C deficiency at inclusion. Vitamin C supplementation strongly improved microvascular reactivity (AUC 2263 [430–4246] vs 5362 [1744–10585] UI, p = 0.0004). In addition, vitamin C supplementation improved mottling score (p = 0.06), finger-tip (p = 0.0003) and knee capillary refill time (3.7 [2.6–5.5] vs 2.9 [1.9–4.7] s, p < 0.0001), as well as and central-to-periphery temperature gradient (6.1 [4.9–7.4] vs 4.6 [3.4–7.0] °C, p < 0.0001). The beneficial effects of vitamin C were observed both in patients with or without vitamin C deficiency. In septic shock patients being resuscitated, vitamin C supplementation improved peripheral tissue perfusion and microvascular reactivity whatever plasma levels of vitamin C. ClinicalTrials.gov Identifier: NCT04778605 registered 26 January 2021.

中文翻译：

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维生素 C 可改善感染性休克患者的微血管反应性和外周组织灌注

维生素 C 通过抗氧化和抗炎特性具有潜在的保护作用。然而，维生素 C 补充剂对人类脓毒症微血管功能和外周组织灌注的影响仍然未知。我们旨在确定维生素 C 对感染性休克患者微血管内皮功能障碍和外周组织灌注的影响。感染性休克患者在初步复苏后被前瞻性纳入。在静脉补充维生素 C (40 mg/kg) 之前和之后 1 小时测量床旁外周组织灌注和皮肤微血管反应对前臂区域乙酰胆碱离子电渗疗法的反应。在研究期间未修改去甲肾上腺素剂量。我们纳入了 30 名感染性休克患者。SOFA 得分为 11 [8-14]，SAPS II 为 66 [54-79]，住院死亡率为33%。这些患者中有一半在纳入时患有维生素 C 缺乏症。补充维生素 C 可显着改善微血管反应性（AUC 2263 [430–4246] vs 5362 [1744–10585] UI，p = 0.0004）。此外，补充维生素 C 可改善斑点评分 (p = 0.06)、指尖 (p = 0.0003) 和膝部毛细血管再充盈时间 (3.7 [2.6–5.5] vs 2.9 [1.9–4.7] s, p < 0.0001)，如以及中心到外围的温度梯度（6.1 [4.9–7.4] vs 4.6 [3.4–7.0] °C，p < 0.0001）。在有或没有维生素 C 缺乏症的患者中都观察到了维生素 C 的有益作用。在复苏的感染性休克患者中，维生素 C 补充剂可改善外周组织灌注和微血管反应性，无论血浆维生素 C 水平如何。ClinicalTrials.gov 标识符：