Usefulness of Antioxidants as Adjuvant Therapy for Septic Shock: A Randomized Clinical Trial.

Alfredo Aisa-Alvarez,Verónica Guarner-Lans,María Elena Soto,Ricardo Gamboa Ávila,Juvenal Franco-Granillo,Enrique A Martínez-Rodríguez,Gilberto Camarena-Alejo,Linaloe Manzano Pech,Israel Pérez-Torres

doi:10.3390/medicina56110619

Alfredo Aisa-Alvarez, Verónica Guarner-Lans + Show 7 more

Open Access

https://doi.org/10.3390/medicina56110619

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Abstract

Background and objectives: Oxidative stress (OS) participates in the pathophysiology of septic shock, which leads to multiple organ failure (MOF), ischemia-reperfusion injury, and acute respiratory distress syndrome. Therefore, antioxidants have been proposed as therapy. Here, we evaluated the effect of antioxidant treatments in patients with septic shock with MOF and determined levels OS before and after treatment. This study was a randomized, controlled, triple-masked, and with parallel assignment clinical trial with a control group without treatment. Materials and Methods: It included 97 patients of either sex with septic shock. 5 treatments were used each in an independent group of 18 patients. Group 1 received vitamin C (Vit C), group 2 vitamin E (Vit E), group 3 n-acetylcysteine (NAC), group 4 melatonin (MT), and group 5 served as control. All antioxidants were administered orally or through a nasogastric tube for five days as an adjuvant to the standard therapy. Results: The results showed that all patients presented MOF due to sepsis upon admission and that the treatment decreased it (p = 0.007). The antioxidant treatment with NAC increased the total antioxidant capacity (p < 0.05). The patients that received Vit C had decreased levels of the nitrate and nitrite ratio (p < 0.01) and C-reactive protein levels (p = 0.04). Procalcitonin levels were reduced by Vit E (p = 0.04), NAC (p = 0.001), and MT (p = 0.04). Lipid-peroxidation was reduced in patients that received MT (p = 0.04). Conclusions: In conclusion, antioxidant therapy associated with standard therapy reduces MOF, OS, and inflammation in patients with septic shock.

Highlights

Damage caused by oxidative stress (OS) participates in the pathophysiology of serious diseases including multiple organ failure (MOF) due to sepsis
Studies in animal models and in patients with septic shock have shown an imbalance between the production of reactive oxygen (ROS) and nitrogen (RNS) species and antioxidant defenses [4]
ROS are generated by phagocytic cells, by the increased activity of enzymes such as NAD(P)H oxidase, xanthine oxidase and inducible nitric oxide and by increased inflammatory mediators through the activation of nuclear factor κB (NFκB) [5]

Summary

Introduction

Damage caused by oxidative stress (OS) participates in the pathophysiology of serious diseases including multiple organ failure (MOF) due to sepsis. Studies in animal models and in patients with septic shock have shown an imbalance between the production of reactive oxygen (ROS) and nitrogen (RNS) species and antioxidant defenses [4]. Oxidative stress (OS) participates in the pathophysiology of septic shock, which leads to multiple organ failure (MOF), ischemia-reperfusion injury, and acute respiratory distress syndrome. We evaluated the effect of antioxidant treatments in patients with septic shock with MOF and determined levels OS before and after treatment. Results: The results showed that all patients presented MOF due to sepsis upon admission and that the treatment decreased it (p = 0.007).

Objectives

Methods

Conclusion