The Application Value Of Ascorbic Acid In Sepsis Treatment

ObjectiveTo research the application value of ascorbic acid in sepsis treatment.MethodsPatients with sepsis were enrolled in the department of Intensive care unit,Dalian Medical University from June 2016 to January 2017,and were divided into Hi-AscA(A),Lo-AscA(B)and Placebo(C)by table of random numbers.All patients were received intravenous infusions every six hours for 96 hours of ascorbic acid[A:150 mg/(kg·d),B:50 mg/(kg·d),C:normal saline).Patients were monitored for plasma levels of ascorbic acid,disease severity[Acute Physiology and Chronic Health Evaluation(APACHE)II score,Multiple Organ Dysfunction Syndrome(MODS)score and Sequential Organ Failure Assessment(SOFA)score],biomarkers of inflammation[procalcitonin(PCT)and C-reactive protein(CRP)],the dose of the active drugs of blood vessels,organ function(liver function,renal function and the duration of ventilator support)and prognosis(28-day mortality and length of ICU stay).The adverse reaction of intravenous ascorbic acid,like worsened arterial hypotension,tachycardia,hypernatremia,and nausea or vomiting were also monitored.Results1.32 patients were enrolled in this study,including 23 males(71.88%)and 9 females(28.12),which mean age was(71.97±15.38)years.The pathogenesis of sepsis were pulmonary infection(24 cases,75%),abdominal infection(5 cases,15.63%)and biliary infection(3 cases,9.37%)in sequence.The numbers of Hi-AscA,Lo-AscA and Placebo were 11 cases,11 cases and 10 cases respectively.The difference of sex,age,pathogenesis of sepsis and temperature,heart rate,mean arterial pressure(MAP),plasma levels of ascorbic acid,disease severity,biomarkers of inflammation and physiological and biochemical indexes before the research between three groups had no statistical significance(all P>0.05),indicating that the three groups of baseline data are comparable.2.The plasma levels of ascorbic acid in patients with sepsis was 0.007g/L,which was significantly lower than that of normal group[(0.009-0.012)g/L,P<0.05)],When the research was started over 24h,the plasma levels of ascorbic acid of patients in group A and group B were significantly higher than those in group C(all P<0.05).The adverse reaction of intravenous ascorbic acid was not observed in group A and group B.3.The rate of 96h change of APACHE Ⅱ score,MODS score and SOFA score in group A and group B were significantly higher than those in group C[APACHE Ⅱscore(-0.40±0.10)vs(-0.42±0.16)vw(-0.11±0.24),PA-C=0.001,PB-C<0.001;PA-C was group A compared with group C,and PB-C was group B compared with group C,similarly hereinafter.MODS score:(-0.53±0.20)vs(-0.48±0.260)vs(-0.28±0.12),PA-C=0.009,PB-C=0.027.SOFA score:(=0.51±0.23)vs(-0.44±0.18)vs(-0.23±0.16),PA-C=0.002,PB-C=0.018].4.The rate of 96h change of PCT and CRP in group A and group B were significantly higher than those in group C[PCT:(-0.80±10.16)vs(-0.75±0.26)vs(0.41±1.22),A-C<0.001,PB-C=0.001.CRP:(-0.81±0.12)vs(-0.63±0.23)vs(0.13±1.38),PA-C=0.010,PB-C=0.033].5.The difference of the dose of norepinephrine between group A,group B and group C had no statistical significance[(84.36±148.26)mg vs(61.09±71.85)mg vs(33.20±39.65)mg,P=0.506].6.The difference of the duration of ventilator support between group A,group B and group C had no statistical significance[(17.36±11.30)d vs(19.36±16.71)d vs(22.80±14.22)d,P=0.682].The rate of 96h change of alanine aminotransferase in group A and group B were significantly lower than those in group C[(0.04±1.11)vs(0.27±0.60)vs(1.78±2.32),PA-C=0.012,PB-C=0.028].When the research was started over 96h,the serum creatinine in group A and group B were significantly higher than those in group C[(66.45±26,51)mg vs(53.00±15.81)mg vs(188.80±227.78)mg,PA-C=0.037,PB-C=0.022].7.The difference of 28-day mortality and length of ICU stay between group A,group B and group C had no statistical significance[28-day mortality:9.10%vs 18.18%vs 10%,P=0.386;length of ICU stay:(20.82±12.86)d vs(28.18±15.20)d vs(30.20±14.57)d,P=0.291].Conclusions1.Intravenous ascorbic acid infusion could effectively inhibit the inflammatory response and lower plasma levels of PCT and CRP.2.Intravenous ascorbic acid infusion could improve liver function and renal function,but could not shorten the duration of ventilator support.3.Although intravenous ascorbic acid infusion could promote the initial recovery of sepsis patients and reduce the scores of disease severity,it remain fails to improve the final prognosis in sepsis patients.4.Intravenous ascorbic acid infusion could not lower the dose of norepinephrine.5.Intravenous ascorbic acid infusion was safe and well tolerated.6.Compared with normal dose,the megadose has no advantages in any aspect.