C-46

Effects of High Dose Vitamin C

Supplementation on Severe COVID-19
Patients In The ICU: A Retrospective Analysis
CKW Wong1, G.R. Letchuman1, KW Foong2, HB Ker1, CL Lim1, BH Lee1, EL Leong3,
XJ Lim3, S. Vijaendreh4, CL Leong5, Nadiah Ismail6
Department of Medicine, Hospital Raja Permaisuri Bainun, Ipoh (HRPB)1; Department of Anaesthesiology and Intensive Care, HRPB2;Clinical Research Centre (CRC), HRPB3;
Department of Obstetrics and Gynaecology, Mahkota Medical Centre, Melaka 4; Department of Medicine, Hospital Kuala Lumpur (HKL)5; CRC, HKL6

Introduction NMRR NO: NMRR-20-684-54478

Approximately 14% of confirmed cases developed severe disease which involves acute lung injury (ALI) and acute respiratory distress syndrome
(ARDS). The triggering factor is a cytokine storm that causes overwhelming oxidative stress which results in severe lung tissue damage. High dose
ascorbic acid (Vitamin C) being an antioxidant that may have the propensity to mitigate such severe oxidative stress in an effort to keep lung injury
minimal besides preventing other organ failures.

Methodology Non
This is a retrospective matched Vitamin C Vitamin
Covid-19
analysis of critically ill COVID-19
patients treated with high dose patient, without Group C Group
Vitamin C
Vitamin C against those without in
two different tertiary hospitals.

COVID-19 treated with

Vitamin C, n=7

Data Collection
Non Vitamin C
Group, n=7
63 Median Age

Days of illness upon

68
7 (1, 10) admission, Median (IQR)
9 (4, 10)
Analysis
Results Comorbidities
71.4% HYPERTENSION 71.4%
Both cohorts showed very similar clinical background, 57.4% DM 71.4%
comorbids, illness severity, and severity score on
42.9% IHD 14.3%
admission. 4 4
14.3% CKD 0.0%
The mortality rate differed in which the Vitamin C
cohort stands at 14.3% while the Non Vitamin C at 57.4% OTHERS 14.3%
4 5 5 5 5 4
71.4%. Clinical improvement in the Vitamin C group 42.9% SMOKER 14.3%
was also reflected by the median change of SOFA
score when the disease progressed (0.5 vs 6). 5 5 5 5 5 5
Baseline
All patients were on oxygen support in which 12 out of
the 14 were on ventilator support. Amongst the
Stage of Illness 5 (4, 14) SOFA 7 (5, 13) Stage of Illness
patients who survived until extubation, days on the
ventilator were shorter in the Vitamin C group Covid-19 Related Medications Usage
compared to non Vitamin C (14 vs 19.6 days). When 100% HYDROXYCHLOROQUINE 100%
looking at duration to complete weaning of oxygen 100% KALETRA 100%
therapy, it was also shorter in Vitamin C group (16 vs
57.1% INTERFERON 1b 100%
23.5 days).
85.7% OSELTAMIVIR 71.4%
Discussion 28.6% HYDROCORTISONE 57.1%
The results above show that there is some signal in 71.4% HEPARIN 85.7%
which high dose Vitamin C may be beneficial in
patients with severe COVID-19 infection. Pertaining to
previous studies done on the COVID-19 cohort, 100% VITAMIN C 0%

many studies have shown high dose vitamin C usage 29%

results in improvement in respiratory function and 14% Result Discharged with
clinical outcome of Covid-19 patients. disabilities

Vitamin C levels in the body may deplete with

infection and high doses are needed to replenish the
stores as well as provide extra in the face of such
stresses. 57% 71%
Protect the tissues from oxidative 29% Discharged Death
well
damage and dysfunction.

Inhibit TNF-α production and in turn, retard Result favors Vitamin C group
the acute hyperinflammatory response.

Assists lung epithelial cell recovery and

surfactant production to improve lung
function and mechanics.
57% lower in 9 days shorter for 5.6 days faster in 7.5 days faster in Weaning
Mortality rate Hospital Stay Successful Extubation off Oxygen Support
Conclusion
There is a signal towards the utility of high dose References Acknowledgement
Vitamin C as an adjunct in the therapy I. Erol, A. (2020). High-dose intravenous vitamin C treatment for COVID-19. We would like to acknowledge
armamentarium of severe COVID-19 infection in II. Carr, A. C. (2020). A new clinical trial to test high-dose vitamin C in patients the Director General of Health,
terms of improved mortality and shorter duration of with COVID-19.
Dr Sharon L Lojikip, SN Wan
III. Wang, L. S., et al. (2020). A review of the 2019 Novel Coronavirus (COVID-
mechanical ventilation. 19) based on current evidence.
Rugayah (HKL), Dr Leong Chin
Tho, Dato Dr Ong Loke Meng,
A future prospective randomized controlled trial will IV. Matthay, M. A., et al. (2020). Treatment for severe acute respiratory
distress syndrome from COVID-19. CRC Penang Team and COVID
be beneficial to investigate this link besides looking V. Hiedra, R., et al. (2020). The Use of IV vitamin C for patients with COVID-19:
Team HRPB for their
at the other organ failure parameters apart from the a single center observational study. contributions towards the
lung. VI. Truwit, J. D., et al. (2019). The CITRIS-ALI randomized clinical trial. success of this study.