key: cord-0826240-881aaxet
authors: Xia, Guozhi; Fan, Di; He, Yanru; Zhu, Yaohu; Zheng, Qiangsun
title: High-dose intravenous vitamin C attenuates hyperinflammation in severe coronavirus disease 2019
date: 2021-06-26
journal: Nutrition
DOI: 10.1016/j.nut.2021.111405
sha: b3097056dda988bd096ae2116399eb12b300928c
doc_id: 826240
cord_uid: 881aaxet

BACKGROUND: High-dose intravenous vitamin C (HIVC) is a major concern on treating coronavirus disease 2019 (COVID-19). OBJECTIVE: To assess the clinical efficacy of HIVC on hyperinflammation among patients with severe COVID-19. METHODS: The retrospective cohort study included inpatients with severe COVID-19, a subset of whom was treated with HIVC. The medical records were screened for demographic data, laboratory findings, medications, as well as initial and repeated values of multiple inflammatory markers for analysis. RESULTS: The percentages of patients presented hyperinflammation based on inflammatory markers levels above upper limit of normal (hs-CRP, 80.1%; IL-6, 91.5%; TNF-a, 67.4%). A total of 85 (36.0%) patients received HIVC therapy. After treatment with HIVC, the levels of inflammatory markers displayed significant decrease related to those among patients without HIVC. Furthermore, the percentages of reduction in inflammatory markers levels were higher in patients receiving HIVC compared with those in patients treated without HIVC. Stepwise multiple linear regression analysis revealed that HIVC was independently associated with percentages of reduction in inflammatory markers levels. CONCLUSIONS: HIVC has potential benefit in attenuating hyperinflammation through reducing inflammatory markers levels in patients with severe COVID-19.

Background: High-dose intravenous vitamin C (HIVC) is a major concern on treating 27 coronavirus disease 2019 (COVID-19). progression to acute respiratory failure and multiorgan dysfunction. [1] However, no optimal 49 strategy is currently available to work well against hyperinflammation caused by severe acute 50 respiratory syndrome coronavirus-2 (SARS-CoV-2), and symptomatic supportive care is the 51 mainstay of treatment. [2] Therefore, it is an urgent need for effective medicine approach to 52 the grim situation.

-4 -High-dose intravenous vitamin C (HIVC) is a major concern on treating COVID- 19 Hyperinflammatory state 129 We identified hyperinflammation with increase of multiple inflammatory markers levels. [8] As 130 shown in Figure 1A , most of patients were in hyperinflammatory state with inflammatory receiving HIVC compared with placebo as seen in our study. [24] The inconsistence between 238 our study and this trial is mainly due to the trial design, and the enrolled patients. 

Clinical features of patients infected with 267 2019 novel coronavirus in Wuhan

Pathophsiology, transmission, 269 diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review

The emerging role of vitamin C in the prevention and treatment of 272 COVID-19

Effect of vitamin C 274 infusion on organ failure and biomarkers of inflammation and vascular injury in patients 275 with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial

Hyper-inflammatory response involves in 278 cardiac injury among patients with coronavirus disease 2019

The Fifth Revised Trial Version of the Novel Coronavirus Pneumonia Diagnosis and 281 Treatment Guidance

The efficiency and safety of high-dose 285 vitamin C in patients with COVID-19: a retrospective cohort study

Markers of hyperinflammation

Weathering the cytokine storm in 290 susceptible patients with severe SARS-CoV-2 infection

Phase I 317 safety trial of intravenous ascorbic acid in patients with severe sepsis

Vitamin C mitigates oxidative stress 320 and tumor necrosis factor-alpha in severe community-acquired pneumonia and 321 LPS-induced macrophages

H rte trun Bu s y Schultz C. Effects of vitamin C on intracytoplasmic cytokine 325 production in human whole blood monocytes and lymphocytes

Therapeutic efficacy of 328 high-dose vitamin C on acute pancreatitis and its potential mechanisms

Pilot trial of high-dose vitamin C in critically 331 ill COVID-19 patients

Diastolic blood pressure, mm Hg

Medications Antiviral, n (%)

HIVC, high-dose intravenous vitamin C; hs-CRP, high-sensitivity C-reactive protein; IL, 368 interleukin

Guozhi Xia: Conceptualization, Methodology, Writing-Reviewing and Editing

Writing-Original draft preparation, software, formal analysis

Validation, Resources. Yaohu Zhu: Investigation, Data curation. Qiangsun Zheng: Supervision