Abstract
Introduction: Sepsis remains a serious and life-threatening condition with high morbidity and mortality. It is marked by imbalance between increased production of free radicals and insufficient neutralization by endogenous antioxidants, including vitamin C. This causes a spread of oxidation reactions and contributes to organ failure. Although this imbalance has been proven to be more marked in burn patients, few studies have focused on the intake of vitamin C in this population.
Objective: Assess hemodynamic impact of high dose vitamin C (100 mg/weight/day) in septic burn patients.
Methods: Case-control study conducted in intensive burn care department in Tunisia during 28 months (July 2019-October 2021). Were included adult burns presenting sepsis or septic shock (as defined in Sepsis 3). Were excluded pregnant woman, patients with history of lithiasis or vesico-renal calculus, of hemochromatosis or G6PD deficiency, and those on long-term vitamin C or glucocorticoids. Only one septic episode was considered per patient during his hospitalization. After inclusion, ascorbic acid was prescribed at a dose of 100 mg/weight/day in 3 doses over 4 days.
The vitamin C group was compared with a retrospective group (non-vitamin C) from the same center matched in terms of age, sex, total body surface area (TBSA) and burn severity. Therapeutic management of sepsis was similar for 2 groups in terms of fluid resuscitation with same hemodynamic objectives (hourly output at 0.5cc to 1cc/weight and MAP > 65 mmHg).
The primary endpoint was the impact of Vit C on hemodynamic state evaluated by fluid resuscitation, dose, and duration of catecholamines.
Results: During study period, 100 patients were included divided into 2 groups: G1 (Vit C+ ; n= 50) and G2 (Vit C- : n= 50). Patients of two groups were comparable in terms of sex, age and severity of burns. Administration of vitamin C reduced fluid balance at day 3 (2 ml/weight/day for G1 vs 13 ml/weight/ day for G2; p= 0,008), reduced significantly doses of noradrenaline at day 3 (1,8 mg/h vs 3,5 mg/h ; p= 0,01), and shortened duration of noradrenaline dependence (4 days for G1 vs 4,84 days for G2 ; p= 0,28) in septic shock burns. No ascorbic acid-related adverse events were identified in the treatment group during the study.
Conclusion: High-dose vitamin C therapy was associated with reduced fluid balance, doses of noradrenaline and duration of dependency in burn patients with septic shock during the first 3 days of sepsis.