Effect of vitamin C in critically ill patients with sepsis and septic shock: A meta-analysis

Systematic review and meta-analysis of nine randomized controlled trials in adult critically ill patients with sepsis or septic shock. The pooled dataset included 584 patients, with 301 in the vitamin C group and 283 in the control group.

Vitamin C was administered mainly intravenously as adjunct therapy, but dosing and duration varied widely across the included trials. Regimens ranged from 450 mg IV for 3 to 6 days and 1 g/day to 50 mg/kg every 6 h for 96 h, 1,500 mg IV four times daily until ICU discharge, or 2.5 mg/kg IV every 6 h for 72 h, compared with placebo or control.

Pooled randomized evidence suggests adjunct vitamin C improved key outcomes in critically ill patients with sepsis or septic shock. Compared with placebo, vitamin C reduced 28-day mortality and lowered vasopressor dose, while ICU length of stay did not differ. Overall, the review supports a potential survival and hemodynamic benefit for vitamin C in this setting.

The evidence base was small, with only nine RCTs and substantial variation in dose, route, and treatment duration across studies. Trial-level heterogeneity and limited reporting of safety and some secondary outcomes reduce confidence in the precision and generalizability of the findings. The authors therefore called for larger, multicenter, high-quality randomized trials.