Abstract
Pneumonia is a severe lower respiratory tract infection that is a common complication and a major cause of mortality of the vitamin C-deficiency disease scurvy. This suggests an important link between vitamin C status and lower respiratory tract infections. Due to the paucity of information on the vitamin C status of patients with pneumonia, we assessed the vitamin C status of 50 patients with community-acquired pneumonia and compared these with 50 healthy community controls. The pneumonia cohort comprised 44 patients recruited through the Acute Medical Assessment Unit (AMAU) and 6 patients recruited through the Intensive Care Unit (ICU); mean age 68 ± 17 years, 54% male. Clinical, microbiological and hematological parameters were recorded. Blood samples were tested for vitamin C status using HPLC with electrochemical detection and protein carbonyl concentrations, an established marker of oxidative stress, using ELISA. Patients with pneumonia had depleted vitamin C status compared with healthy controls (23 ± 14 µmol/L vs. 56 ± 24 µmol/L, p < 0.001). The more severe patients in the ICU had significantly lower vitamin C status than those recruited through AMAU (11 ± 3 µmol/L vs. 24 ± 14 µmol/L, p = 0.02). The pneumonia cohort comprised 62% with hypovitaminosis C and 22% with deficiency, compared with only 8% hypovitaminosis C and no cases of deficiency in the healthy controls. The pneumonia cohort also exhibited significantly elevated protein carbonyl concentrations compared with the healthy controls (p < 0.001), indicating enhanced oxidative stress in the patients. We were able to collect subsequent samples from 28% of the cohort (mean 2.7 ± 1.7 days; range 1–7 days). These showed no significant differences in vitamin C status or protein carbonyl concentrations compared with baseline values (p = 0.6). Overall, the depleted vitamin C status and elevated oxidative stress observed in the patients with pneumonia indicates an enhanced requirement for the vitamin during their illness. Therefore, these patients would likely benefit from additional vitamin C supplementation to restore their blood and tissue levels to optimal. This may decrease excessive oxidative stress and aid in their recovery.
Highlights
Pneumonia is a severe lower respiratory tract infection that can be caused by bacterial, fungal and viral pathogens, including the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) [1,2].Lower respiratory tract infections are the leading cause of morbidity and mortality for communicableNutrients 2020, 12, 1318; doi:10.3390/nu12051318 www.mdpi.com/journal/nutrientsNutrients 2020, 12, 1318 disease worldwide [3]
Two case control studies have indicated that patients with pneumonia have significantly lower vitamin C status than healthy controls, and there was an inverse correlation with the severity of the condition [12,13]
We found significantly elevated protein carbonyls in the patients with pneumonia compared with healthy controls
Summary
Pneumonia is a severe lower respiratory tract infection that can be caused by bacterial, fungal and viral pathogens, including the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) [1,2].Lower respiratory tract infections are the leading cause of morbidity and mortality for communicableNutrients 2020, 12, 1318; doi:10.3390/nu12051318 www.mdpi.com/journal/nutrientsNutrients 2020, 12, 1318 disease worldwide [3]. Lower respiratory tract infections are the leading cause of morbidity and mortality for communicable. In 2016, lower respiratory tract infections resulted in more than 65 million hospital admissions and nearly 2.4 million deaths worldwide [4]. Pneumonia is a common complication and a major cause of mortality of the vitamin C deficiency disease scurvy, which suggests an important link between vitamin C status and lower respiratory tract infections [8]. Two other studies that explored the time course indicated that up to 40% of patients with pneumonia exhibited vitamin C deficiency (i.e., plasma vitamin C concentrations
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