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A new clinical trial to test high-dose vitamin C in patients with COVID-19

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L E T T E R Open Access
A new clinical trial to test high-dose
vitamin C in patients with COVID-19
Anitra C. Carr
With the 2019 novel coronavirus (2019-nCoV) outbreak
now spreading across the world, people are seeking ways
in which to potentially protect themselves from the virus
or to alleviate its effects once caught. One such means that
is being touted online and in the media is vitamin C.
Vitamin C is best known for its antioxidant properties,
being able to scavenge damaging reactive oxygen species,
thus protecting the bodys cells and tissues from oxida-
tive damage and dysfunction. However, the vitamin also
has numerous other important functions within the
body, many of which are known to support healthy im-
mune function. During infection, vitamin C levels can
become depleted and a persons requirement for vitamin
C increases with the severity of the infection [1]. In se-
vere cases, this may require intravenous administration
of gram doses in order to achieve high enough levels in
the body to compensate for the enhanced turnover of
the vitamin.
As of February 2020, the clinical characteristics of pa-
tients hospitalized with COVID-19-related pneumonia in-
dicated that 26% were transferred to the ICU because of
complications such as ARDS and shock [2]. A recently
published RCT carried out in the USA in 167 patients
with sepsis-related ARDS indicated that administration of
~ 15 g/day of IV vitamin C for 4 days may decrease mor-
tality in these patients [3]. An earlier IV vitamin C trial of
patients admitted to the ICU with pneumonia included
hydrocortisone administration [4], however, systemic cor-
ticosteroid treatment has not been shown to have signifi-
cant benefits in patients with COVID-19 [5].
Just recently registered on (Identifier:
NCT04264533), a new clinical trial to investigate vitamin
C infusion for the treatment of severe 2019-nCoV in-
fected pneumonia has begun in Wuhan, China. This is
one of the first RCTs to test the effects of IV vitamin C
in patients infected with this virus. In this trial, the in-
vestigators will treat 140 patients with a placebo control
or intravenous vitamin C at a dose of 24 g/day for 7 days.
They will assess requirements for mechanical ventilation
and vasopressor drugs, organ failure scores, ICU length
of stay and 28-day mortality.
The investigators of the new study hope to complete
the trial by the end of September. Although the findings
of this trial will be too late for the many thousands of
people currently infected with the virus, the study will
nevertheless provide valuable information as to the po-
tential mitigation of symptoms by vitamin C during fu-
ture viral outbreaks.
ACC is the recipient of a Health Research Council of New Zealand Sir Charles
Hercus Health Research Fellowship.
Authors contributions
ACC wrote the letter. The author read and approved the final manuscript.
Availability of data and materials
Ethics approval and consent to participate
Consent for publication
Competing interests
Received: 10 March 2020 Accepted: 25 March 2020
1. Carr AC, Rosengrave PC, Bayer S, Chambers S, Mehrtens J, Shaw GM.
Hypovitaminosis C and vitamin C deficiency in critically ill patients despite
recommended enteral and parenteral intakes. Crit Care. 2017;21:300.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit
The Creative Commons Public Domain Dedication waiver ( applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
Department of Pathology & Biomedical Science, University of Otago,
Christchurch, PO Box 4345, Christchurch 8140, New Zealand
Carr Critical Care (2020) 24:133
2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z,
Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138
hospitalized patients with 2019 novel coronavirus-infected pneumonia in
Wuhan, China. JAMA. 2020;323(11):1061-9.
3. Fowler AA 3rd, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, Fisher B,
Thacker LR 2nd, Natarajan R, Brophy DF, Sculthorpe R, Nanchal R, Syed A,
Sturgill J, Martin GS, Sevransky J, Kashiouris M, Hamman S, Egan KF, Hastings
A, Spencer W, Tench S, Mehkri O, Bindas J, Duggal A, Graf J, Zellner S,
Yanny L, McPolin C, Hollrith T, Kramer D, Ojielo C, Damm T, Cassity E,
Wieliczko A, Halquist M. 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. 2019;322(13):126170.
4. Kim WY, Jo EJ, Eom JS, Mok J, Kim MH, Kim KU, Park HK, Lee MK, Lee K.
Combined vitamin C, hydrocortisone, and thiamine therapy for patients
with severe pneumonia who were admitted to the intensive care unit:
propensity score-based analysis of a before-after cohort study. J Crit Care.
5. Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, Xiao W, Wang YN, Zhong
MH, Li CH, Li GC, Liu HG. Clinical characteristics of novel coronavirus cases
in tertiary hospitals in Hubei Province. Chin Med J. 2020.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Carr Critical Care (2020) 24:133 Page 2 of 2
... In addition to its nutritional significance, AA is also used in medical practice and in clinical trials for the treatment of many diseases including hypovitaminosis C, severe pneumonia, severe acute respiratory failure, coronary artery disease, Type 2 diabetes, dementia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. However, the benefit of using this dietary antioxidant in prophylactics and the treatment of cancer has been under debate mentia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. ...
... In addition to its nutritional significance, AA is also used in medical practice and in clinical trials for the treatment of many diseases including hypovitaminosis C, severe pneumonia, severe acute respiratory failure, coronary artery disease, Type 2 diabetes, dementia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. However, the benefit of using this dietary antioxidant in prophylactics and the treatment of cancer has been under debate mentia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. However, the benefit of using this dietary antioxidant in prophylactics and the treatment of cancer has been under debate for several decades already [14][15][16][17][18][19][20][21][22][23][24][25][26]. ...
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Ascorbic acid is a multifaceted compound that can perform both antioxidant and pro-oxidant activities in the redox reactions induced by transition metal ions, so its role in nature and especially in the human body is still the subject of debate. In the present study, we have examined the influence of ascorbic acid on lipid peroxidation in a model system that mimics the cell membrane, namely micelles of linoleic acid (LA), induced by chelate complexes of iron and copper ions with quinone-chelator 2-phenyl-4-(butylamino)-naphtholquinoline-7,12-dione (Q1). This quinone effectively generates reactive oxygen species and semiquinone radicals inside cancer cells via a cycling redox reaction. Here it was demonstrated that the absence of quinone-chelator ascorbic acid significantly accelerates the lipid peroxidation induced by both Fe(II) and Cu(II) ions. It has been shown also that Q1 chelate complexes with Fe(II) and Cu(II) ions are redox active in the LA micelles oxidation. No effect of ascorbate was detected on the reactivity of chelate complex with Fe(II) ions. On the other hand, ascorbate performs pro-oxidant activity in Q1-Cu(II) complex induced reaction. We can conclude that ascorbate-driven redox cycling of Q1 may promote its anti-tumor activity.
... During an infection, vitamin C levels can become depleted and a person's requirement for vitamin C increases with the severity of the infection. As of February 2020, the clinical characteristics of patients hospitalized with COVID-19-related pneumonia indicated that 26% [76] . One trial with 140 patients, IV vitamin C was administered to ICU patients with pneumonia at a dose of 24 g/day for 7 days along with hydrocortisone to the therapy, however, this combination did not result any benefits for patients with COVID-19 [77] . ...
... In addition to vitamin C, polyphenols, and flavonoids can play a protective role in lung infections, being immune modulators and inflammatory mediators. [76] Other public health measures ...
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Coronavirus disease 2019 (COVID-2019) is the newest pandemic haunting human life from late 2019 to this day, caused by a novel coronavirus known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) accounting for more than 15 Million positive cases by July of 2020 and over 6 lakh deaths. An overview about coronavirus infection describes in brief its origin, pathology, clinical features, diagnostic methods, process of transmission and the mainstay treatment options along with the upcoming strategies to combat the light speed spread of the infection. The public measures undertaken to halt disease spread has proven to be effective to the extent of public understanding and readiness to comply to the needful. No obvious therapy has yet been stated for Covid-19 infection although the existing medications are being used in a plethora of studies. Among the new drugs targeted for this infection are: Remdesivir and potential vaccines in the early stages of human trials.
... Vitamin C increases cortisol production, which enhances the anti-inflammatory and endothelial impacts of the glucocorticoides [35]. Exogenous glucocorticoid steroids are the only proven COVID-19 treatment modification [36]. The figure depicts the strategies for treating COVID-19 pathology of vitamin C. ...
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COVID-19 is a highly-transmissible, newly emerged, and pathogenic virus in humans which has caused economic disasters as well as global public health issues. To date, millions of mortalities and infections were reported globally and the numbers are continuing to rise. Due to the continual improvements in medical science, various vaccine types were identified and able to reduce the disease's virulence to some extent. However, there is currently no effective treatment for the disease. Enhanced nutrition, including vitamin supplementation to enhance the immune system, was discovered as a viable therapy for alleviating and preventing the severity of COVID-19. To lower the mortalities related to acute respiratory distress, various dietary therapies and alternate supportive treatments are being utilized and tested in patients experiencing COVID-19. A systematic literature review was conducted to uncover nutritional therapies which might assist individuals to recover from COVID-19. Furthermore, electronic databases Science Direct, Google Scholar, PubMed, Scopus, and Web of Science have been searched from February 2020 to April 2021. The purpose of the presented work was give a vision how successful early micronutrient intervention, with an emphasis on vitamin C, vitamin D, and zinc, was at decreasing the escalation of COVID-19, along with the impact of other vitamins in boosting the immune system as well as preventing further complications and improving death rates.-91. ‫الفترة‬ ‫خالل‬ ‫فبراير‬ 0202 ‫أبريل‬ ‫الى‬ ‫و‬ 0209 ‫البحث‬ ‫تم‬ ، ‫بياناات‬ ‫قواعد‬ ‫في‬ ‫ًا‬ ‫إلكتروني‬ PubMed ‫و‬ Science Direct ‫و‬ Scopus ‫و‬ Web of Science ‫و‬ Google Scholar ‫الدراسة‬ ‫هذه‬ ‫من‬ ‫الهدف‬ ‫وكان‬. ‫فعالية‬ ‫حول‬ ‫رؤية‬ ‫إعطاء‬ ‫الدقيقة‬ ‫للمغذيات‬ ‫المبكر‬ ‫التدخل‬ ‫فيتامين‬ ‫على‬ ‫التركيز‬ ‫مع‬ ، D ‫و‬ C ‫تصاعد‬ ‫من‬ ‫الحد‬ ‫في‬ ، ‫والزنك‬ ‫إصابة‬ ‫اعراض‬ ‫كوفيد‬-91 ‫دور‬ ‫وكذلك‬ ، ‫المن‬ ‫جهاز‬ ‫تعزيز‬ ‫في‬ ‫األخرى‬ ‫الفيتامينات‬ ‫وبالتا‬ ‫اعة‬ ‫الوفيات.‬ ‫من‬ ‫والحد‬ ‫المضاعفات‬ ‫من‬ ‫المزيد‬ ‫منع‬ ‫لي
... Recently, investigations to validate its effect in severe COVID-19 treatment have begun (Carr 2020). Vitamin C may possess effects on viral infections of the respiratory tract especially when specific therapy for COVID-19 is absent. ...
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The immune system protects human health from the effects of pathogenic organisms; however, its activity is affected when individuals become infected. These activities require a series of molecules, substrates, and energy sources that are derived from diets. The consumed nutrients from diets help to enhance the immunity of infected individuals as it relates to COVID-19 patients. This study aims to review and highlight requirement and role of macro- and micronutrients of COVID-19 patients in enhancing their immune systems. Series of studies were found to have demonstrated the enhancing potentials of macronutrients (carbohydrates, proteins, and fats) and micronutrients (vitamins, copper, zinc, iron, calcium, magnesium, and selenium) in supporting the immune system’s fight against respiratory infections. Each of these nutrients performs a vital role as an antiviral defense in COVID-19 patients. Appropriate consumption or intake of dietary sources that yield these nutrients will help provide the daily requirement to support the immune system in its fight against pathogenic viruses such as COVID-19.
... High-dose (1.5 mg/kg body weight) vitamin C has been employed clinically for several decades. NIH panel also clearly showed that this amount is safe, being not accompanied by significant side effects [65,66]. The reactive oxygen species generated by the cytokine storm could be counteracted by administering 30e60 g vitamin C, while relatively high amounts of vitamin C can trigger chemotaxis of white blood cells (neutrophils, macrophages, lymphocytes, B cells, NK cells) [66]. ...
oxidative stress is caused by an abundant generation of reactive oxygen species, associated to a diminished capacity of the endogenous systems of the organism to counteract them. Activation of pro-oxidative pathways and boosting of inflammatory cytokines are always encountered in viral infections, including SARS-CoV-2. So, the importance of counteracting cytokine storm in COVID-19 pathology is highly important, to hamper the immunogenic damage of the endothelium and alveolar membranes. Antioxidants prevent oxidative processes, by impeding radical species generation. It has been proved that vitamin intake lowers oxidative stress markers, alleviates cytokine storm and has a potential role in reducing disease severity, by lowering pro-inflammatory cytokines, hampering hyperinflammation and organ failure. For the approached compounds, direct antiviral roles are also discussed in this review, as these activities encompass secretion of antiviral peptides, modulation of angiotensin-converting enzyme 2 receptor expression and interaction with spike protein, inactivation of furin protease, or inhibition of pathogen replication by nucleic acid impairment induction. Vitamin administration results in beneficial effects. Nevertheless, timing, dosage and mutual influences of these micronutrients should be carefullly regarded.
... Thus, patients may need higher doses with the severity of the infection [13]. To better understand the potential and safety of vitamin C as a part of COVID-19 treatment, often administered intravenously in a range of 15 to 24 g daily, an increasing number of clinical trials is planned or in a process already [14]. One recent pilot trial has shown that the addition of a high dose of vitamin C infusion (24 g per day for seven days) to the standard care treatment for severe COVID-19 did not affect ventilation-free days but may provide a potential benefit in oxygenation and IL-6 level, without adverse events observed [15]. ...
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Commercially available food supplements, especially vitamins and minerals, are becoming increasingly popular in the era of COVID-19 pandemic. Sales of food supplements increased dynamically because of the belief that they could be more effective than conventional antiviral or corticosteroid drugs as well as missing the specific medical therapy for preventing or treating this disease. The greatest interest is associated with immune-related nutrients and antioxidant agents, including vitamin C, vitamin D, vitamin E, selenium (Se), and zinc (Zn). These are currently under clinical investigation for possible application in the prevention and management of COVID-19. This review summarizes postulated mechanisms of commonly used supplements suggested reducing the duration and severity of viral infections by improving immune response. Their toxicity in the context of potential adverse effects is also discussed. Whether these molecules and the amount could hurt patients with COVID-19 are research questions worth evaluating. Considering both efficacy and safety, evidence supporting larger intakes of specific nutrients with immune-boosting and/or antioxidant properties needs further research. Until relevant responses are provided, age and gender related tolerable upper intake levels for vitamins and minerals should be considered to avoid weight gaining as an additional risk factor of developing complications during the disease course, besides the risk of inappropriate doses associated with toxicity. Herein, high-quality information respecting specific nutrients proposed to have positive effect against COVID-19 is disseminated and certain research gaps are addressed, requiring the research on the health effects of supplements to be tightly correlated to age, nutritional status, wellbeing and particular to existing co-morbidities.
... While some studies show little or no impact, evidence from two Cochrane systematic reviews suggest that a daily vitamin C dose of 1-2 g is safe, inexpensive, and consistently reduces the duration and severity of the common cold in people exposed to increased stress, intense physical exercise, and cold environment, yet has no impact on colds' incidence, duration or severity in the general population (Douglas et al., 2007;Hemilä and Chalker, 2013). In the COVID-19 context, the efficacy and safety of high-doses of vitamin C supplementation are currently under investigation and have not been proven yet (Bellavite and Donzelli, 2020;Carr, 2020;Feyaerts and Luyten, 2020). ...
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Introduction Since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, there has been a marked increase in the use of diets and dietary supplements (DDS) for the prevention and treatment of this emerging disease. While DDS are generally regarded as harmless, little evidence exists on the safety and efficacy of their use for COVID-19. Objectives To investigate the pattern and determinants of DDS use among the United Arab Emirates (UAE) population for the prevention and treatment of COVID-19. Design: Cross-sectional web-based survey. Setting: Adults residing in the UAE. Participants: Participants (n= 2,060) residing in the UAE were recruited from databases of the Supreme Council for Family Affairs - Sharjah networks in the various Emirates. Primary and Secondary Outcomes: Prevalence and determinants for the use of different DDS for the prevention and treatment of COVID-19 in the UAE, and sources of information for DDS use. Results The majority of participants reported using a form of the DDS understudy, with special foods being the most common (95.5%), followed by intake of citrus fruits (62.1%), supplements use (56.6%), increased water intake (50%), and herbal teas (38.4%). Only 20% of participants reported the main source of information on DDS to be health care practitioners, with the majority relying on either social media (40.4%) or family and friends (28.7%). After adjustment, female gender, older age (>40 years), and Asian ethnicities were characteristics associated with higher odds of using most of the DDS modalities and were also correlates of reporting health care practitioners as the main source of information for their DDS use. Conclusions The findings showed widespread use of DDS for the prevention and treatment of COVID-19. The use of DDS in this study was mainly guided by social media with a marginal role of health care practitioners. These findings call for a more integrative approach towards DDS to ensure its proper and safe use.
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The coronavirus disease 2019 (COVID-19) is a deadly viral infection causing death due to impaired immunity. Therefore, an investigation of factors affecting the immune system should be considered. It is well documented that regular sessions of moderate-intensity exercise training with up to 1-hour duration boost the immune functions through anti-inflammatory and antioxidant effects. Besides, a diet containing functional and nutritious foods is also needed to aid the immune system. Herein, we have summarized available data on how exercise and nutritional factors help promote immunity against various infections. More importantly, this review provides practical and valuable guidance for sedentary adult people and non-professional athletes on how to do aerobic and resistance training and stretching exercises at home with no special types of equipment required during the outbreaks of delta variant-COVID-19. Some significant exercise-related nutritional considerations regarding carbohydrates, fibers, vitamins, zinc, and omega-3 fatty acids were also supplied that help to create better adaptations and improve immune responses.
Качество метаболической компенсации диабета определяет не только скорость прогрессирования его осложнений, но и состояние противовирусного и противомикробного иммунитета. Обсуждается реализация международных руководств по лечению диабета во время острых респираторных инфекций и COVID-19. Международные рекомендации по коррекции внутрибольничной дисгликемии, собственный опыт авторов указывают на возможность индивидуализации гликемических параметров при внутривенном введении короткого или ультракороткого инсулина в отделении интенсивной терапии и реанимации (ОИТР) на основе оценки метаболического статуса пациентов и ожидаемых перспектив. Выживаемость выше при более жестких целевых значениях гликемии при минимизации гипогликемий. Можно ли перенести этот клинический опыт на ситуацию с внутрибольничной гипергликемией у пациентов ОИТР с COVID-19, покажут в дальнейшем результаты анализа эффективности различных терапевтических подходов, включая применение ряда лекарственных средств. The quality of metabolic compensation of diabetes determines not only the rate of progression of its complications, but also the state of antiviral and antimicrobial immunity. Implementation of international Guidelines for Treating Diabetes During Acute Respiratory Viral Infections and COVID-19 is discussed. Meanwhile, the international guidelines on intrahospital hyperglycemia, as well as own experience, indicate the feasibility of individualizing glycemic targets with intravenous administration of short or ultrashort insulin in the ICU for patients based on their metabolic status and expected prospects. Survival rates are higher at lower glycemic targets. If it is possible to transfer this clinical experience to the situation of intrahospital hyperglycemia in ICU patients with COVID-19 will show the results of the analysis of the effectiveness of different therapeutic approaches in the ICU in the future, including the use of a number of drugs.
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Background: A novel coronavirus (2019-nCoV) causing an outbreak of pneumonia in Wuhan, Hubei province of China was isolated in January 2020. This study aims to investigate its epidemiologic history, and analyzed the clinical characteristics, treatment regimens, and prognosis of patients infected with 2019-nCoV during this outbreak. Methods: Clinical data from 137 2019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30, 2019 to January 24, 2020 were collected, including general status, clinical manifestations, laboratory test results, imaging characteristics, and treatment regimens. Results: None of the 137 patients (61 males, 76 females, aged 20-83 years, mean age 55 ± 16 years) had a definite history of exposure to Huanan Seafood Wholesale Market. Major initial symptoms included fever (112/137, 81.8%), coughing (66/137, 48.2%), and muscle pain or fatigue (44/137, 32.1%), with other, less typical initial symptoms observed at low frequency, including heart palpitations, diarrhea, and headache. Nearly 80% of the patients had normal or decreased white blood cell counts, and 72.3% (99/137) had lymphocytopenia. Lung involvement was present in all cases, with most chest computed tomography scans showing lesions in multiple lung lobes, some of which were dense; ground-glass opacity co-existed with consolidation shadows or cord-like shadows. Given the lack of effective drugs, treatment focused on symptomatic and respiratory support. Immunoglobulin G was delivered to some critically ill patients according to their condition. Systemic corticosteroid treatment did not show significant benefits. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea. Conclusions: The majority of patients with 2019-nCoV coronavirus pneumonia present with fever as the first symptom, and most of them still showed typical manifestations of viral pneumonia on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.
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Importance In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited. Objective To describe the epidemiological and clinical characteristics of NCIP. Design, Setting, and Participants Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020. Exposures Documented NCIP. Main Outcomes and Measures Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked. Results Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 10⁹/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0). Conclusions and Relevance In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.
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Purpose: To evaluate the efficacy of combined vitamin C, hydrocortisone, and thiamine in patients with severe pneumonia. Materials and Methods: All consecutive patients with severe pneumonia who were treated with the vitamin C protocol (6 g of vitamin C per day) in June 2017–January 2018 (n = 53) were compared to all consecutive patients with severe pneumonia who were treated in June 2016–January 2017 (n = 46). Propensity score analysis was used to adjust for potential baseline differences between the groups. Results: In the propensity-matched cohort (n = 36/group), the treated patients had significantly less hospital mortality than the control group (17% vs. 39%; P = 0.04). The vitamin C protocol associated independently with decreased mortality in propensity score-adjusted analysis (adjusted odds ratio = 0.15, 95% confidence interval = 0.04–0.56, P = 0.005). Relative to the control group, the treatment group had a significantly higher median improvement in the radiologic score at day 7 compared with baseline (4 vs. 2; P = 0.045). The vitamin C protocol did not increase the rates of acute kidney injury or superinfection. Conclusions: Combined vitamin C, hydrocortisone, and thiamine therapy may benefit patients with severe pneumonia.
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Background Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this study we have assessed plasma vitamin C concentrations in critically ill patients relative to infection status (septic shock or non-septic) and level of inflammation (C-reactive protein concentrations). Vitamin C status was also assessed relative to daily enteral and parenteral intakes to determine if standard intensive care unit (ICU) nutritional support is adequate to meet the vitamin C needs of critically ill patients. Methods Forty-four critically ill patients (24 with septic shock, 17 non-septic, 3 uncategorised) were recruited from the Christchurch Hospital Intensive Care Unit. We measured concentrations of plasma vitamin C and a pro-inflammatory biomarker (C-reactive protein) daily over 4 days and calculated patients’ daily vitamin C intake from the enteral or total parenteral nutrition they received. We compared plasma vitamin C and C-reactive protein concentrations between septic shock and non-septic patients over 4 days using a mixed effects statistical model, and we compared the vitamin C status of the critically ill patients with known vitamin C bioavailability data using a four-parameter log-logistic response model. ResultsOverall, the critically ill patients exhibited hypovitaminosis C (i.e., < 23 μmol/L), with a mean plasma vitamin C concentration of 17.8 ± 8.7 μmol/L; of these, one-third had vitamin C deficiency (i.e., < 11 μmol/L). Patients with hypovitaminosis C had elevated inflammation (C-reactive protein levels; P < 0.05). The patients with septic shock had lower vitamin C concentrations and higher C-reactive protein concentrations than the non-septic patients (P < 0.05). Nearly 40% of the septic shock patients were deficient in vitamin C, compared with 25% of the non-septic patients. These low vitamin C levels were apparent despite receiving recommended intakes via enteral and/or parenteral nutritional therapy (mean 125 mg/d). Conclusions Critically ill patients have low vitamin C concentrations despite receiving standard ICU nutrition. Septic shock patients have significantly depleted vitamin C levels compared with non-septic patients, likely resulting from increased metabolism due to the enhanced inflammatory response observed in septic shock.