Date of Graduation

Summer 8-10-2019

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: Sepsis is the leading cause of death in critically ill patients worldwide, with over a 30-50% mortality rate. The inflammatory response that occurs in sepsis is known to cause multi-system organ failure, followed quickly by death. The current mainstay for treatment of sepsis is intravenous fluid resuscitation to maintain hemodynamic stability, antibiotics to combat infection, and the use of vasopressors, or vasoconstrictors for refractory hypotension. Since sepsis causes such an inflammatory response, and most critically ill patients present with hypovitaminosis C due to oxidative stress from infection, the thought of adding vitamin C to the sepsis bundle has been recently studied. Vitamin C is easily accessible, affordable and safe for those patients suffering from sepsis. Its own antioxidant and anti-inflammatory properties, along with its connection to synthesizing endogenous norepinephrine and vasopressin, make it an exciting new possibility to decrease global mortality.

Methods: An exhaustive search of online literature was conducted using MEDLINE, CINAHL, Google Scholar, and Web of Science. Keywords used in the search included sepsis, septic shock, vitamin C and ascorbic acid. These results were screened for eligibility, and articles that assessed the mortality of septic shock patients in the ICU were included. These studies were then appraised and assessed for quality of evidence by GRADE.

Results: Two studies met the inclusion criteria, studied the same primary outcome of mortality, and were included in this systemic review. One RCT took 28 patients in the ICU and found a significant decrease in hospital mortality, along with a decreased dose and duration needed for vasopressors when vitamin C was administered in the treatment group versus the control group. A retrospective observational study of 94 patients, (n=47) in both the treatment and control group who used a combination of steroids, thiamine and vitamin C found a propensity adjusted odds ratio of mortality in those treated with the vitamin C protocol to be 0.13.

Conclusion: The addition of vitamin C may prove to be an added benefit to the sepsis bundles in the ICU. Further research needs to be done with larger patient populations in order to accurately confirm Vitamin C’s effect on improving septic patients’ mortality outcomes.

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