VITAMIN C DEFICIENCY IN PATIENTS WITH SHOCK IS ASSOCIATED WITH POOR OUTCOMES

Abstract

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The use of Vitamin C (VC) therapy in patients with septic shock has recently been explored due to its anti-oxidative and anti-inflammatory properties. However, the prevalence and impact of VC deficiency among critically-ill patients in shock is unclear. We sought to determine the prevalence of VC deficiency as well as its association on clinical outcomes. METHODS: We conducted a retrospective cohort study of patients admitted to the intensive care unit (ICU) at Kaiser Permanente Los Angeles Medical Center with a diagnosis of shock from March 1, 2018 to June 30, 2018. The study included all causes of shock defined as hypotension requiring vasopressor therapy. VC serum concentrations were collected upon admission to the ICU. Data on demographics and comorbidities were collected. We compared outcomes, including survival at 7-, 30-, and 90-days, and vasopressor free days at 30-days between VC deficient and VC sufficient subjects. Logistic regression was used to estimate odds ratios (OR). Chi-square and Fisher’s exact test were used to determine statistical significance for categorical variables. P-value <0.05 was considered statistically significant. RESULTS: The study examined 145 patients, of which, 51 were VC deficient. With VC sufficient subjects as reference, estimated risks of 7-day survival compared to VC deficient subjects were OR 2.1; 95% CI, 0.86-5.10, p= 0.10. VC deficient patients had an increased risk in 30-day mortality, OR 2.52; 95% CI 1.24-5.12, p= 0.01, compared to VC sufficient patients. VC deficient patients also had increased risk in 90-day mortality OR 3.06; 95% CI 1.5-6.24, p= 0.002, compared to VC sufficient patients. VC deficient subjects also averaged fewer vasopressor free days, [means (SD): 14.7 (11.96) vs 21.5 (10.36), OR 0.94; 95% CI 0.92-0.98, p= 0.0009]. Patients with chronic kidney disease (CKD) were four times more likely to be VC deficient, OR 4.06 (1.76-9.3), p= 0.0009. CONCLUSIONS: Medical ICU patients account for the majority of ICU cases. There is a small percentage of cardiogenic shock patients given the presence of a designated Coronary Care Unit. Prevalence of VC deficiency among the study population was five times higher than the US general population (35% vs 7%). VC deficiency was associated with decreased survival at 30 days and 90 days when compared to VC sufficient subjects. There was no significant difference in mortality at 7 days. VC deficiency was also associated with fewer vasopressor free days. History of CKD was the highest predictor for VC deficiency. Our findings suggest that VC deficient subjects presenting with shock are at greater risk for poor outcomes. Therefore, studies should further explore the use of VC therapy in subjects at higher risk. CLINICAL IMPLICATIONS: Literature has not explored mortality benefit in Vitamin C deficient patients. Thus, VC therapy in this subset of patients must be studied. DISCLOSURES: No relevant relationships by Dinora Chinchilla, source=Web Response No relevant relationships by Ngoc Ho, source=Web Response No relevant relationships by Brannen Liang, source=Web Response No relevant relationships by Kenneth Wei, source=Web Response