![]() ![]() Several preclinical studies and two clinical studies demonstrated that high-dose vitamin C can reduce fluid infusion and subsequent edema. ![]() Experimental studies showed that vitamin C can decrease oxidative stress in endothelial cells and tighten endothelial barriers. Vitamin C, or ascorbic acid, is an inexpensive and readily available antioxidant commonly deployed in the clinical settings. Reactive oxygen species contribute to increased endothelial permeability. However, increased capillary permeability allows escape of intravascular fluid and proteins into the interstitial space. A massive volume of intravenous fluid is usually required to ensure adequate end-organ perfusion. Severe burns require appropriate fluid management in the acute phase. While “high-dose” vitamin C therapy lacks a universal definition, the present study reveals that different “high-dose” regimens may yield improved outcomes. High-dose vitamin C therapy was associated with reduced mortality in patients with severe burns when used under a minimum threshold of 10 g within the first 2 days of admission. In contrast, in-hospital mortality did not differ between the control and high-dose vitamin C group under the > 24-g threshold (risk ratio, 0.83 95% confidence interval, 0.68–1.02 p = 0.068). Under this particular threshold, high-dose vitamin C therapy was associated with reduced in-hospital mortality (risk ratio, 0.79 95% confidence interval, 0.66–0.95 p = 0.006). After 1:4 propensity score matching, we compared 157 and 628 patients who were administered high-dose vitamin C ( > 10-g threshold) and controls, respectively. ResultsĮligible patients ( n = 2713) were categorized into the vitamin C group ( n = 157) or control group ( n = 2556). The primary outcome was in-hospital mortality. High-dose vitamin C was defined as a dosage in excess of 10 g or 24 g within 2 days of admission. Propensity score matching was performed between patients who received high-dose vitamin C within 1 day of admission (vitamin C group) and those who did not (control group). We enrolled adult patients with severe burns (burn index ≥ 15) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2016. This study evaluates the effect of high-dose vitamin C in severe burn patients under two varying thresholds. Vitamin C is a well-documented antioxidant that reduces oxidative stress and fluid infusion in high doses however, the association between high-dose vitamin C and reduced mortality remains unclear. ![]()
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