2 more NEGATIVE studies of #VitaminC in #sepsis: #ACTS in @JAMA_current & #ATESS in @yourICM.
It' doesn’t look good for the "metabolic cure”
5/6 negative for 1° endpoints; ORANGES found ⬇️ pressor use
5/6 with no mortality Δ; CITRIS did, but mortality was 1 of 46 2° endpoints
1/
This is a great time to do some meta-analysis.
As you can see from my quick/simple analysis, neither vitamin C either alone or in combination with hydrocortisone and steroids reduced in mortality in people with sepsis:
2/
What about other endpoints? It doesn't look much better for vitamin C: 4/6 found no ΔSOFA scores.
Also, while ΔSOFA scores and duration of vasopressors are important, I would argue that mortality is a more meaningful (and more patient centered) endpoint.
3/
Bottom Line:
I've been excited but skeptical since the Marik paper.
Since 2017, there have been several RCTs that have failed to replicate those results.
Now I’m pretty sure #VitaminC doesn’t work.
In the ICU as in life, when something seems too good to be true it probably is
4/
Methods:
This is a binary random effects model looking at 28 or 30-day mortality using #OpenMetaAnalyst and the MetaFor package in #Rstats version 3.6.2
For those interested in doing your own analysis you can download my data here: dropbox.com/s/a2k83j3a09ps…
5/
Also for convenience, here are links to the RCTs of #vitaminC in sepsis:
* CITRIS-ALI bit.ly/309vt9h
* VITAMINS bit.ly/2BFYRul
* HYVCTTSSS bit.ly/2EwC6tZ
* ORANGES bit.ly/3fbfjjO
* ACTS bit.ly/3kVJGiy
* ATESS bit.ly/34au8RU
6/
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