Effect of IV High-Dose Vitamin C on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsSato R, Hasegawa D, Prasitlumkum N, Ueoka M, Nishida K, Takahashi K, Nasu M, Dugar S. Crit Care Med. 2021 Dec 1;49(12):2121-2130. Doi: 10.1097/CCM.0000000000005263. ObjectivesThe aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to investigate whether IV high-dose vitamin C improves the short-term mortality of patients with sepsis.目的本研究的目的是对随机对照试验进行系统评价和荟萃分析，以评估静脉注射高剂量维生素C是否能改善脓毒症患者的短期病死率。 DesignThis study is a systematic review and meta-analysis of randomized controlled trials. We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for randomized controlled trials that met inclusion criteria. The protocol was registered at the University hospital Medical Information Network Clinical Trials Registry (UMIN000040528). All analyses were presented with the use of random-effects models. The primary outcome was short-term mortality defined as 28-day, 30-day, or in-hospital mortality.设计本研究是对随机对照试验的系统评价和荟萃分析。我们检索了荷兰《医学文摘》（EMBASE）、Cochrane 对照试验中央登记库和美国国立医学图书馆中符合纳入标准的随机对照试验。该协议在大学医院医学信息网络临床试验注册处注册（UMIN000040528）。所有分析均使用随机效应模型进行呈现。主要结果是短期病死率，定义为 28 天、30 天或住院病死率。 PatientsTwo authors independently evaluated the following eligibility criteria: 1) randomized controlled trial, 2) patients with sepsis aged ≥18 years, and 3) received intravenous high-dose vitamin C in addition to standard of care, or standard of care alone. Then, two authors independently extracted the selected patient and study characteristics and outcomes from studies that met above eligibility criteria.人群两位作者独立评估研究是否符合以下入选标准：1) 随机对照试验，2) ≥ 18 岁的脓毒症患者，3) 接受静脉注射高剂量维生素C患者，除了标准护理或仅接受标准护理患者除外。然后，两位作者分别从符合上述入选标准的研究中提取选定的患者、研究特征和结果。 Measurements and main resultsEleven randomized controlled trials (n = 1,737 patients) were included in this meta-analysis. High-dose IV vitamin C was not associated with a significantly lower short-term mortality (risk ratio, 0.88; 95% CI, 0.73–1.06; p = 0.18; I 2 = 29%) but was associated with a significantly shorter duration of vasopressor use (standardized mean difference, –0.35; 95% CI, –0.63 to –0.07; p < 0.01; I 2 = 80%) and a significantly greater decline in the Sequential Organ Failure Assessment score at 72–96 hours (standardized mean difference, –0.20; 95% CI, –0.32 to –0.08; p < 0.01; I 2 = 16%). One study reported significant association with hypernatremia, but adverse effects were rare, and high-dose vitamin C is deemed relatively safe.测量和结果本荟萃分析包括 11 项随机对照试验（n = 1,737 名患者）。高剂量静脉注射维生素 C 不能显著降低脓毒症患者的短期病死率（风险比，0.88；95% CI，0.73～1.06；p = 0.18；I 2 = 29%），但可以显著缩短的血管活性药物应用时间（标准化平均差，–0.35；95% CI，–0.63 至 –0.07；p < 0.01；I 2 = 80%），而且可以显著降低72～96 小时的SOFA评分（标准化平均 差异，–0.20；95% CI，–0.32 至 –0.08；p < 0.01；I 2 = 16%）。高剂量静脉注射维生素 C被认为相对安全，不良反应很少见，其中一项研究报告了与高钠血症的相关联。
ConclusionsIn this meta-analysis, the use of IV high-dose vitamin C in patients with sepsis was not associated with lower short-term mortality although it was associated with significantly shorter duration of vasopressor use and greater decline in the Sequential Organ Failure Assessment score at 72-96 hours.结论这项荟萃分析中发现，静脉注射高剂量维生素 C并不能降低脓毒症患者的短期病死率，但可以显著缩短脓毒症患者血管升压药的使用时间，可以显著降低脓毒症患者72～96 小时的SOFA评分。 首都医科大学附属北京地坛医院 侯斐 译 刘景院 校首都医科大学附属北京天坛医院 重症医学科 周益民 编辑
