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Cited by 202Clinical Nutrition and GastroenterologySepsis Diagnosis and TreatmentVitamin C and Antioxidants Research

Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients

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Berger, Mette M, Soguel, Ludivine, Shenkin, Alan, Revelly, Jean-Pierre, Pinget, Christophe, Baines, Malcolm, Chioléro, René L·2008·Critical Care
DOI 10.1186/cc6981PMC PMC2575590
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Abstract

Introduction: Oxidative stress is involved in the development of secondary tissue damage and organ failure. Micronutrients contributing to the antioxidant (AOX) defense exhibit low plasma levels during critical illness. The aim of this study was to investigate the impact of early AOX micronutrients on clinical outcome in intensive care unit (ICU) patients with conditions characterized by oxidative stress. Methods: We conducted a prospective, randomized, double-blind, placebo-controlled, single-center trial in patients admitted to a university hospital ICU with organ failure after complicated cardiac surgery, major trauma, or subarachnoid hemorrhage. Stratification by diagnosis was performed before randomization. The intervention was intravenous supplements for 5 days (selenium 270 μg, zinc 30 mg, vitamin C 1.1 g, and vitamin B 1 100 mg) with a double-loading dose on days 1 and 2 or placebo. Results: Two hundred patients were included (102 AOX and 98 placebo). While age and gender did not differ, brain injury was more severe in the AOX trauma group (P = 0.019). Organ function endpoints did not differ: incidence of acute kidney failure and sequential organ failure assessment score decrease were similar (-3.2 ± 3.2 versus -4.2 ± 2.3 over the course of 5 days). Plasma concentrations of selenium, zinc, and glutathione peroxidase, low on admission, increased significantly to within normal values in the AOX group. C-reactive protein decreased faster in the AOX group (P = 0.039). Infectious complications did not differ. Length of hospital stay did not differ (16.5 versus 20 days), being shorter only in surviving AOX trauma patients (-10 days; P = 0.045). Conclusion: The AOX intervention did not reduce early organ dysfunction but significantly reduced the inflammatory response in cardiac surgery and trauma patients, which may prove beneficial in conditions with an intense inflammation. Trials Registration: Clinical Trials.gov RCT Register: NCT00515736.

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  • Circulating levels of copper, selenium, zinc, and vitamins E and C are decreased below reference ranges in severe critical care conditions in association with intense inflammation.

    “The antioxidant micronutrients, and in particular copper, selenium, zinc, and vitamins E and C belong to the primary antioxidant defenses: their circulating levels are decreased below reference ranges in these conditions (282,283,284,285) in association with intense inflammation.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [282]

    The Introduction (page unavailable) says low plasma selenium in sepsis or shock correlates with inflammation and that the acute-phase response depletes circulating micronutrients. The Results, under Biological variables (page unavailable), report that selenium and zinc concentrations were in the lower normal ranges on admission, with 69% of selenium values below the lower reference value. The paper does not establish that circulating copper or vitamins E and C were below reference ranges, or that all five nutrients were below those ranges in the patients studied. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • High-dose vitamin C can augment antibacterial defenses.

    “Finally, high-dose vitamin C can augment antibacterial defenses (282).”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [282]

    The Discussion (Rationale for the micronutrient doses and combinations; page unavailable) says high-dose vitamin C was included to reinforce antioxidant defenses, not antibacterial defenses. The Results (Outcome variables; page unavailable) report that infectious complications did not differ between the supplemented and placebo groups. The study therefore does not establish an antibacterial benefit from vitamin C, which was given as part of a combination. (LLM, conf=0.84)

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Authors
Berger, M. M., Soguel, L., Shenkin, A., Revelly, J.-P., Pinget, C., Baines, M., & Chioléro, R. L.
Affiliations
  • Centre Hospitalier Universitaire Vaudois (CH)
  • University of Liverpool (GB)
Corresponding author
Berger, Mette M
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2008-08-07
Volume
12
Issue
4
Pages
R101-R101
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/cc6981
PMC
PMC2575590
OpenAlex
W2121313585
Cited by
202
References
54
Citations by year
2026: 1 · 2025: 7 · 2024: 8 · 2023: 11 · 2022: 7 · 2021: 6 · 2020: 14 · 2019: 17 · 2018: 8 · 2017: 8 · 2016: 9 · 2015: 14 · 2014: 9 · 2013: 11 · 2012: 15
FWCI
17.81
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion, other-oa)
Funders
Centre Hospitalier Universitaire Vaudois
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
Keywords
antioxidant supplementation, oxidative stress, selenium, zinc, vitamin C, thiamine, organ failure, cardiac surgery, severe trauma, subarachnoid hemorrhage, inflammation, C-reactive protein, glutathione peroxidase, acute kidney injury, length of hospital stay, critically ill patients
MeSH terms
Adult, Aged, Aged, 80 and over, Antioxidants, Double-Blind Method, Female, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Multiple Organ Failure, Prospective Studies, Subarachnoid Hemorrhage, Time Factors, Critical Illness, Cerebrovascular Trauma, Young Adult

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