静脉注射维生素C对脓毒症与脓毒性休克患者预后的影响: 随机对照试验的Meta分析

Effect of vitamin C intravenous injection on prognosis of patients with sepsis or septic shock: A Meta-analysis of randomized controlled trial

摘要:

目的 评估静脉注射维生素C对脓毒症患者的疗效。 方法 计算机检索PubMed、Embase、Scopus、Cochrane Library和Clinical Trials数据库, 检索时限为建库至2022年12月。收集静脉注射维生素C治疗脓毒症或脓毒性休克的随机对照试验(RCT)英文文献。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后, 采用RevMan 5.3软件和Stata 15.0软件进行Meta分析。 结果 共纳入16项RCT研究, 包括3 301例患者。主要结局方面, 维生素C治疗组患者28天病死率略低于对照组, 但差异无统计学意义[RR=0.86, 95%CI(0.72~1.03), P=0.10; I²=44%, P=0.10]。次要结局方面, 静脉注射维生素C可缩短血管活性药物使用时间[MD=-23.44, 95%CI(-30.53~-16.35), P＜0.01;I²=0, P=0.97], 但对患者90天病死率、重症监护病房(ICU)病死率、医院病死率、机械通气持续时间、72 h序贯器官衰竭估计评分差值(△SOFA)、ICU住院时间、总住院时间无明显影响(P＞0.05)。 结论 静脉注射维生素C可明显缩短血管活性药物使用时间, 但现有证据尚不足以支持静脉注射维生素C可改善脓毒症或脓毒性休克患者的预后。需要更多高质量、多中心的RCT研究提供更多关于维生素C治疗脓毒症或脓毒性休克疗效的实质性证据。

Abstract:

Objective To evaluate the efficacy of vitamin C intravenous injection in the treatment of patients with sepsis. Methods PubMed, Embase, Scopus, Cochrane Library, and Clinical Trial databases were retrieved, with a retrieval period from database establishment to December 2022. English literatures on randomized controlled trial (RCT) of vitamin C intravenous injection for the treatment of sepsis or septic shock were collected. Meta-analysis was conducted using RevMan 5.3 software and Stata 15.0 software after literature screening, extraction, and evalua- tion of the bias risk included in the studies by two researchers independently. Results A total of 16 RCT studies involving 3 301 patients were included in the analysis. In terms of main outcomes, the 28-day mortality of patients in the vitamin C treatment group was slightly lower than that of the control group, but the difference was not statistically significant (RR=0.86, 95%CI [0.72-1.03], P=0.10; I²=44%, P=0.10). In terms of secondary outcomes, vitamin C intravenous injection can reduce the duration of vasoactive drug usage time (MD=-23.44, 95%CI [-30.53--16.35], P < 0.01; I²=0, P=0.97), but has no significant effect on the 90-day mortality, intensive care unit mortality, hospital mortality, duration of mechanical ventilation, difference in estimated sequential organ failure assessment score at 72 hour, length of stay in ICU, and total length of hospital stay of patients (P > 0.05). Conclusion Intravenous vitamin C injection can significantly reduce vasoactive drug usage time, but the available evidence is insufficient to support that intravenous vitamin C can improve the prognosis of patients with sepsis or septic shock. More high-quality, multicenter randomized controlled trial is needed to provide more substantial evidence about the efficacy of vitamin C in treating sepsis or septic shock.