TY - JOUR
T1 - Vitamin therapy in sepsis
AU - Wald, Eric L.
AU - Badke, Colleen M.
AU - Hintz, Lauren K.
AU - Spewak, Michael
AU - Sanchez-Pinto, L. Nelson
N1 - Funding Information:
E.L.W. and L.N.S.-P. conceived and designed the review and supervised all aspects of the work. E.L.W. and L.K.H. were responsible for the vitamin C section; C.M.B. was responsible for the vitamin A and D sections; M.S. was responsible for the vitamin B1 section; and L.N.S.-P. was responsible for the vitamin B2, B9, B12, and E sections. E.L.W. and L.N.S.-P. were responsible for the first draft of the document and for editing the manuscript. No internal or external financial support was provided.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
PY - 2022/1
Y1 - 2022/1
N2 - Abstract: Vitamins are essential micronutrients with key roles in many biological pathways relevant to sepsis. Some of these relevant biological mechanisms include antioxidant and anti-inflammatory effects, protein and hormone synthesis, energy generation, and regulation of gene transcription. Moreover, relative vitamin deficiencies in plasma are common during sepsis and vitamin therapy has been associated with improved outcomes in some adult and pediatric studies. High-dose intravenous vitamin C has been the vitamin therapy most extensively studied in adult patients with sepsis and septic shock. This includes three randomized control trials (RCTs) as monotherapy with a total of 219 patients showing significant reduction in organ dysfunction and lower mortality when compared to placebo, and five RCTs as a combination therapy with thiamine and hydrocortisone with a total of 1134 patients showing no difference in clinical outcomes. Likewise, the evidence for the role of other vitamins in sepsis remains mixed. In this narrative review, we present the preclinical, clinical, and safety evidence of the most studied vitamins in sepsis, including vitamin C, thiamine (i.e., vitamin B1), and vitamin D. We also present the relevant evidence of the other vitamins that have been studied in sepsis and critical illness in both children and adults, including vitamins A, B2, B6, B12, and E. Impact: Vitamins are key effectors in many biological processes relevant to sepsis.We present the preclinical, clinical, and safety evidence of the most studied vitamins in pediatric sepsis.Designing response-adaptive platform trials may help fill in knowledge gaps regarding vitamin use for critical illness and association with clinical outcomes.
AB - Abstract: Vitamins are essential micronutrients with key roles in many biological pathways relevant to sepsis. Some of these relevant biological mechanisms include antioxidant and anti-inflammatory effects, protein and hormone synthesis, energy generation, and regulation of gene transcription. Moreover, relative vitamin deficiencies in plasma are common during sepsis and vitamin therapy has been associated with improved outcomes in some adult and pediatric studies. High-dose intravenous vitamin C has been the vitamin therapy most extensively studied in adult patients with sepsis and septic shock. This includes three randomized control trials (RCTs) as monotherapy with a total of 219 patients showing significant reduction in organ dysfunction and lower mortality when compared to placebo, and five RCTs as a combination therapy with thiamine and hydrocortisone with a total of 1134 patients showing no difference in clinical outcomes. Likewise, the evidence for the role of other vitamins in sepsis remains mixed. In this narrative review, we present the preclinical, clinical, and safety evidence of the most studied vitamins in sepsis, including vitamin C, thiamine (i.e., vitamin B1), and vitamin D. We also present the relevant evidence of the other vitamins that have been studied in sepsis and critical illness in both children and adults, including vitamins A, B2, B6, B12, and E. Impact: Vitamins are key effectors in many biological processes relevant to sepsis.We present the preclinical, clinical, and safety evidence of the most studied vitamins in pediatric sepsis.Designing response-adaptive platform trials may help fill in knowledge gaps regarding vitamin use for critical illness and association with clinical outcomes.
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U2 - 10.1038/s41390-021-01673-6
DO - 10.1038/s41390-021-01673-6
M3 - Review article
C2 - 34333556
AN - SCOPUS:85111648128
SN - 0031-3998
VL - 91
SP - 328
EP - 336
JO - Pediatric research
JF - Pediatric research
IS - 2
ER -