THE ROLE OF ASCORBIC ACID IN REDUCING THE INCIDENCE OF STAGE 3 ACUTE KIDNEY INJURY IN PATIENTS WITH SEPTIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: The use of ascorbic acid or vitamin C in patients with septic shock is a topic of significant investigation. Some argue it decreases both morbidity and mortality in patients with septic shock, while others state that it provides no additional changes in a patient's outcome. This literature review looks at patients with septic shock, and investigates the role of high dose vitamin C (HDVC) in reducing the rate of stage 3 acute kidney injury (AKI), intensive care unit (ICU) mortality, hospital mortality, and length of ICU stay. METHODS: A thorough search of the literature was conducted to perform a meta-analysis of the available studies that compared the efficacy of HDVC to standard care or placebo in patients with septic shock. This search was performed using PubMed, Embase, and Cochrane for data on the subject matter of study from inception to April 20, 2021. We only considered randomized controlled trials for our analysis. From each study, we collected the number of patients with septic shock who underwent treatment with either HDVC or standard care/placebo. The primary outcome was the rate of stage 3 AKI. Secondary outcomes were ICU mortality, hospital mortality, and length of ICU stay. The random-effects model was used to calculate the risk ratios (RR), mean differences (MD), and confidence intervals (CIs). A p-value <0.05 was considered statistically significant. Heterogeneity was assessed using Higgins I2 index. RESULTS: Nine randomized controlled trials involving 1503 patients were including in the meta-analysis. Five studies reported the rate of stage 3 AKI, and it was not significantly lower in those receiving HDVC when compared to standard care/placebo (39.0% vs. 37.5%, RR 1.03, 95% CI 0.89-1.20, p= 0.68, I2= 0%). Four studies reported the rate of ICU mortality, and it was not significantly lower in those receiving HDVC when compared to standard care/placebo (20.1% vs. 18.6%, RR 1.07, 95% CI 0.84-1.38, p= 0.58, I2= 0%). Six studies reported the rate of hospital mortality, and it was not significantly lower in those receiving HDVC when compared to standard care/placebo (22.5% vs. 25.7%, RR 0.88, 95% CI 0.55-1.40, p= 0.58, I2= 73%). Six studies reported length of ICU stay, which was found to be similar between both the HDVC and standard care/placebo groups (MD= 0.02 days, 95% CI -0.10-0.15, p= 0.73, I2= 0%). CONCLUSIONS: Our meta-analysis demonstrates that the use of HDVC for patients with septic shock does not significantly reduced the rate of stage 3 AKI, ICU mortality, or hospital mortality. HDVC also does not did not significantly reduce the length of ICU stay. Further data should be collected to confirm our findings. CLINICAL IMPLICATIONS: The use of HDVC for patients with septic shock is not effective in reducing occurrence stage 3 AKI when compared to standard care/placebo. However, the use HDVC also does not significantly increase the rate of mortality and length of ICU stay. DISCLOSURES: No relevant relationships by Hyder Ali, source=Web Response No relevant relationships by Modar Alom, source=Web Response No relevant relationships by Mohammed Awad, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by prabath herath mudiyanselage, source=Web Response No relevant relationships by Saffa Iftikhar, source=Web Response No relevant relationships by Nithin Kesireddy, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Rakin Rashid, source=Web Response