Intravenous vitamin C administration in septic shock may have a sparing effect on vasopressor requirements, and vitamin C’s enzyme cofactor functions provide a mechanistic rationale. Our study aimed to determine the effect of intravenous vitamin C administration on vasopressor requirements and other outcomes in patients with septic shock. This was a double-blind, randomised placebo-controlled trial in 40 patients with septic shock who were randomised (1:1) to receive intravenous vitamin C (at a dose of 25 mg/kg of body weight every 6 h) or placebo (intravenous 5% dextrose) for up to 96 h, or until death or discharge. The primary outcome was intravenous vasopressor requirements (dose and duration), and secondary outcomes included Sequential Organ Failure Assessment (SOFA) scores, intensive care unit (ICU) and hospital length of stay, and mortality. In addition, blood samples were collected to determine vitamin C kinetics and inflammatory marker concentrations. Median plasma vitamin C concentrations were deficient at baseline (9.2 [4.4, 12] µmol/L) and increased to 408 (227, 560) µmol/L following 72 h of intervention. The mean duration of intravenous vasopressor infusion in the vitamin C group was 48 (95% CI 35–62) hours and in the placebo group was 54 (95% CI 41–62) hours (p = 0.52). The dose of vasopressor delivered over time was comparable between the two groups, as were SOFA scores (p > 0.05). The median ICU length of stay in the intervention group was 3.8 (2.2, 9.8) days versus 7.1 (3.1, 20) days in the placebo group (p = 0.12). The median hospital length of stay for the vitamin C group was 18 (11, 35) days versus 22 (10, 52) days for the placebo group (p = 0.65). Mortality was comparable between the two groups (p > 0.05). Of the inflammatory markers, neutrophil counts were elevated in the vitamin C group relative to placebo by 72 h (p = 0.01). C-reactive protein and myeloperoxidase concentrations were elevated at baseline, however, the two groups were comparable over time (p > 0.05). Our pilot study indicated that intravenous vitamin C did not provide significant decreases in the mean dose or duration of vasopressor infusion. Further research that takes into account the potential impact of intervention timing, dose and duration, and location of trial, may provide more definitive evidence. ACTRN12617001184369 (11/8/2017).

中文翻译：

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脓毒症休克患者静脉注射维生素 C：一项随机对照试验


败血性休克中静脉注射维生素 C 可能对升压药的需求有一定影响，而维生素 C 的酶辅因子功能提供了机械原理。我们的研究旨在确定静脉注射维生素 C 对感染性休克患者升压药需求和其他结局的影响。这是一项双盲、随机安慰剂对照试验，受试者为 40 名感染性休克患者，他们被随机 (1:1) 接受静脉注射维生素 C（剂量为每 6 小时 25 毫克/公斤体重）或安慰剂（静脉注射 5% 葡萄糖）长达 96 小时，或直至死亡或出院。主要结局是静脉升压药需求（剂量和持续时间），次要结局包括序贯器官衰竭评估（SOFA）评分、重症监护病房（ICU）和住院时间以及死亡率。此外，还收集了血液样本以确定维生素 C 动力学和炎症标志物浓度。基线时中位血浆维生素 C 浓度不足（9.2 [4.4, 12] µmol/L），干预 72 小时后增加至 408 (227, 560) µmol/L。维生素 C 组静脉升压药的平均持续时间为 48 (95% CI 35-62) 小时，安慰剂组为 54 (95% CI 41-62) 小时 (p = 0.52)。随着时间的推移，两组之间的血管加压药剂量相当，SOFA 评分也相当 (p > 0.05)。干预组的中位 ICU 住院时间为 3.8 (2.2, 9.8) 天，而安慰剂组为 7.1 (3.1, 20) 天 (p = 0.12)。维生素 C 组的中位住院时间为 18 (11, 35) 天，而安慰剂组为 22 (10, 52) 天 (p = 0.65)。两组之间的死亡率相当（p > 0.05）。 在炎症标志物中，维生素 C 组的中性粒细胞计数相对于安慰剂组升高了 72 小时 (p = 0.01)。 C 反应蛋白和髓过氧化物酶浓度在基线时升高，但随着时间的推移，两组具有可比性 (p > 0.05)。我们的初步研究表明，静脉注射维生素 C 并未显着降低血管加压药输注的平均剂量或持续时间。进一步研究考虑干预时机、剂量和持续时间以及试验地点的潜在影响，可能会提供更明确的证据。 ACTRN12617001184369（2017 年 11 月 8 日）。