Abstract
Background: Coronavirus disease 2019 (COVID-19) pandemic is continuing to impact multiple countries worldwide and effective treatment options are still being developed. In this study, we investigate the potential of high-dose intravenous vitamin C (HDIVC) in the prevention of moderate COVID-19 disease aggravation. Methods: In this retrospective before-after case-matched clinical study, we compare the outcome and clinical courses of patients with moderate COVID-19 patients who were treated with an HDIVC protocol (intravenous injection of vitamin C, 100 mg/kg/day, 1 g/h, for 7 days from admission) during a one-month period (between March 18 and april 18, 2020, HDIVC group) with a control group treated without the HDIVC protocol during the preceding two months (January 18 to March 18, 2020). Patients in the two groups were matched in a 1:1 ratio according to age and gender. Results: The HDIVC and control groups each comprised 55 patients. For the primary outcomes, there was a significant difference in the number of patients that evolved from moderate to severe type between the two groups (HDIVC: 4/55 vs. control: 12/55, relative risk [RR] = 0.28 [0.08, 0.93], P = 0.03). Compared to the control group, there was a shorter duration of systemic inflammatory response syndrome (SIRS) (P = 0.0004) during the first week and lower SIRS occurrence (2/21 vs 10/22, P = 0.0086) on Day 7 (6–7 days after admission). In addition, HDIVC group had lower C-reactive protein levels (P = 0.005) and higher number of CD4+ T cells from Day 0 (on admission) to Day 7 (P = 0.04).” The levels of coagulation indicators, including activated partial thromboplastin time and D-dimer were also improved in the HDIVC compared to the control group on Day 7. Conclusion: HDIVC may be beneficial in limiting disease aggravation in the early stage of COVID-19 pneumonia, which may be related to its improvements on the inflammatory response, immune function and coagulation function. Further randomized controlled trials are required to augment these findings.
Highlights
The potentially fatal disease, coronavirus disease 2019 (COVID19), has caused a worldwide pandemic since December 2019 (Mahase, 2020; Spinelli and Pellino, 2020)
We did not directly show the effect of high-dose intravenous vitamin C (HDIVC) on cytokines, we have demonstrated the shorter duration of systemic inflammatory response syndrome (SIRS) and less SIRS prevalence in the HDIVC compared to the control group during the first week after admission
This confirmed the beneficial effect of HDIVC on coagulation disorders. This finding might be explained by the fact that vitamin C exerts an improving effect on endothelial damage (Barabutis et al, 2017), which promotes microvascular clot formation and angiopathy in COVID-19 pneumonia (Iba et al, 2020b). In this retrospective before-after study, we found that fewer COVID-19 pneumonia patients suffered disease aggravation after HDIVC application
Summary
The potentially fatal disease, coronavirus disease 2019 (COVID19), has caused a worldwide pandemic since December 2019 (Mahase, 2020; Spinelli and Pellino, 2020). The severe type is mainly characterized by deteriorating respiratory function and rapid progression of radiological lesions, while the critical type further requires mechanical ventilation and is accompanied by shock or multiple organ failure. These two types are reported to be associated with a mortality rate as high as 66% (Wu et al, 2020). One of the keys to improving the prognosis of COVID-19 is to prevent disease aggravation, especially when the disease severity ranges from moderate, through severe, to critical type. Coronavirus disease 2019 (COVID-19) pandemic is continuing to impact multiple countries worldwide and effective treatment options are still being developed. We investigate the potential of high-dose intravenous vitamin C (HDIVC) in the prevention of moderate COVID-19 disease aggravation
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