High-dose vitamin C ameliorates cardiac injury in COVID-19 pandemic: a retrospective cohort study
Guozhi Xia, Bowen Qin, Chaoran Ma, Yaowu Zhu, Qiangsun Zheng
Background: Cardiac injury is common and associated with poor clinical outcomes in COVID-19. Data are lacking whether high-dose intravenous vitamin C (HIVC) could help to ameliorate myocardial injury in the pandemic. Methods: The retrospective cohort study included consecutive severe and critically ill COVID-19 patients with cardiac injury receiving symptomatic supportive treatments alone or together with HIVC. Troponin I and inflammatory markers were collected at admission and day 21 during hospitalization from the electronic medical records. Results: The patients (n = 113) were categorized into the ameliorated cardiac injury (ACI) group (n = 70) and the non-ameliorated cardiac injury (NACI) group (n = 43). Overall, fifty-one (45.1%) patients were administered with HIVC, the percentages of patients with HIVC were higher in the ACI group than those in the NACI group. Logistic regression analysis revealed that HIVC was independently associated with the improvement of myocardial injury. Further analysis showed that inflammatory markers levels significantly decreased at day 21 during hospitalization in patients with HIVC therapy compared to those administered with symptomatic supportive treatments alone. Meanwhile, similar results were also observed regarding changes in inflammatory markers levels from baseline to day 21 during hospitalization in the patients treated with HIVC. Conclusions: HIVC can ameliorate cardiac injury through alleviating hyperinflammation in severe and critically ill patients with COVID-19.
AUTHOR CONTRIBUTIONS Xia G conceived and designed of the study. Xia G and Zhu Y collected the clinical data and laboratory values. Xia G and Ma C drafted the article. Xia G and Qin B conducted the statistical analysis and interpreted the data. Zheng Q provided valuable guidance in every stage of the writing of this thesis. All authors read and approved the final manuscript.
CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.
References
Basili, Tanzilli, Mangieri, Raparelli, Santo et al., Intravenous ascorbic acid infusion improves myocardial perfusion grade during elective percutaneous coronary intervention: relationship with oxidative stress markers, JACC Cardiovasc Interv,
doi:10.1016/j.jcin.2009.10.025Bavishi, Bonow, Trivedi, Abbott, Messerli et al., Special Article -Acute myocardial injury in patients hospitalized with COVID-19 infection: A review, Prog Cardiovasc Dis,
doi:10.1016/j.pcad.2020.05.013Carr, Rowe, The Emerging Role of Vitamin C in the Prevention and Treatment of COVID-19, Nutrients,
doi:10.3390/nu12113286Fowler Aa 3rd, Syed, Knowlson, Sculthorpe, Farthing et al., Unit Nursing. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis, J Transl Med,
doi:10.1186/1479-5876-12-32Fowler Aa 3rd, Truwit, Hite, Morris, Dewilde et al., Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial, JAMA,
doi:10.1001/jama.2019.11825Kashiouris, Heureux, Cable, Fisher, Leichtle et al., The Emerging Role of Vitamin C as a Treatment for Sepsis, Nutrients,
doi:10.3390/nu12020292Lin, Li, Interpretation of "Guidelines for the Diagnosis and Treatment of Novel Coronavirus
Madjid, Vela, Khalili-Tabrizi, Casscells, Litovsky, Systemic infections cause exaggerated local inflammation in atherosclerotic coronary arteries: clues to the triggering effect of acute infections on acute coronary syndromes, Tex Heart Inst J
Min, Cheon, Ha, Sohn, Kim et al., Comparative and kinetic analysis of viral shedding and immunological responses in MERS patients representing a broad spectrum of disease severity, Sci Rep,
doi:10.1038/srep25359Qin, Zhou, Hu, Zhang, Yang et al., Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China, Clin Infect Dis,
doi:10.1093/cid/ciaa248Shi, Qin, Shen, Cai, Liu et al., Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China, JAMA Cardiol,
doi:10.1001/jamacardio.2020.0950Wang, Hu, Liu, Shi, Cheng et al., The effect of intravenous vitamin C infusion on periprocedural myocardial injury for patients undergoing elective percutaneous coronary intervention, Can J Cardiol,
doi:10.1016/j.cjca.2013.08.018Xia, Fan, He, Zhu, Zheng, High-dose intravenous vitamin C attenuates hyperinflammation in severe coronavirus disease 2019, Nutrition,
doi:10.1016/j.nut.2021.111405Xia, Ma, He, Wang, Zhu et al., Hyper-Inflammatory Response Involves in Cardiac Injury Among Patients With Coronavirus Disease 2019, Am J Med Sci,
doi:10.1016/j.amjms.2021.02.007Yang, Tang, Aberrant coagulation causes a hyperinflammatory response in severe influenza pneumonia, Cell Mol Immunol,
doi:10.1038/cmi.2016.1Zhang, Rao, Li, Zhu, Liu et al., Pilot trial of high-dose vitamin C in critically ill COVID-19 patients, Ann Intensive Care,
doi:10.1186/s13613-020-00792-3
