From the Research
The Citris-ALI trial was a randomized clinical trial that evaluated the use of high-dose vitamin C (ascorbic acid) in patients with sepsis and acute respiratory distress syndrome (ARDS) 1. The trial administered 50 mg/kg of intravenous vitamin C every 6 hours for 96 hours to patients in the treatment group, compared to placebo. The results showed that vitamin C did not significantly improve the primary outcomes of organ dysfunction scores or markers of inflammation and vascular injury. However, there was a secondary finding of reduced 28-day mortality in the vitamin C group, though this was not a primary endpoint. The trial included 167 patients across seven medical intensive care units. Despite the mortality difference, the lack of improvement in the primary outcomes means that high-dose vitamin C cannot be routinely recommended for sepsis and ARDS treatment based on this trial alone. The biological rationale for testing vitamin C included its antioxidant properties and potential to reduce oxidative stress in critical illness, as well as its role in endothelial function and immune response. Vitamin C levels are typically depleted in critically ill patients, which provided additional justification for the intervention. Some studies have suggested that vitamin C may have beneficial effects on biomarkers of inflammation and vascular injury, such as C-reactive protein and thrombomodulin levels 2. However, the CITRIS-ALI trial did not find significant differences in these biomarkers between the vitamin C and placebo groups. Other studies have also investigated the use of vitamin C in sepsis and ARDS, with mixed results 3. Overall, the evidence suggests that high-dose vitamin C may have some potential benefits in sepsis and ARDS, but further research is needed to fully understand its effects and to determine its potential role in treatment. Key points about the Citris-ALI trial include:
- The trial was a randomized, double-blind, placebo-controlled, multicenter trial
- The trial included 167 patients with sepsis and ARDS
- The treatment group received 50 mg/kg of intravenous vitamin C every 6 hours for 96 hours
- The primary outcomes were change in organ failure scores and biomarkers of inflammation and vascular injury
- The trial did not find significant differences in the primary outcomes between the vitamin C and placebo groups.