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Open AccessArticle

Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

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Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, D-52074 Aachen, Germany
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Department of Anesthesiology, Medical Faculty RWTH Aachen, D-52074 Aachen, Germany
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3CARE—Cardiovascular Critical Care and Anesthesia Evaluation and Research, D-52074 Aachen, Germany
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Medical Student of the Medical Faculty RWTH Aachen University, D-52074 Aachen, Germany
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Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada
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Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, CA K7L 2V7, Canada
*
Authors to whom correspondence should be addressed.
Nutrients 2019, 11(9), 2103; https://doi.org/10.3390/nu11092103
Received: 29 June 2019 / Revised: 27 August 2019 / Accepted: 29 August 2019 / Published: 4 September 2019
Background: Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ-protective micronutrient. Past clinical trials and meta-analyses have focused predominantly on occurrence of postoperative atrial fibrillation. Therefore, we investigated the influence of perioperative vitamin C administration on clinically relevant parameters closer related to the patient’s recovery, especially organ function, and overall outcomes after cardiac surgery. Methods: Randomized controlled trials (RCTs) comparing perioperative vitamin C administration versus placebo or standard of care in adult patients undergoing cardiac surgery were identified through systematic searches in Pubmed, EMBASE, and CENTRAL on 23 November 2018. Published and unpublished data were included. Assessed outcomes include organ function after cardiac surgery, adverse events, in-hospital mortality, intensive care unit, and hospital length-of-stay. Data was pooled only when appropriate. Results: A total of 19 RCTs with 2008 patients were included in this meta-analysis. Vitamin C significantly decreased the incidence of atrial fibrillation (p = 0.008), ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and hospital length-of-stay (p < 0.0001). However, on average, vitamin C had no significant effects on in-hospital mortality (p = 0.76), or on the incidence of stroke (p = 0.82). High statistical heterogeneity was observed in most analyses. Conclusions: Vitamin C impacts clinically and economically important outcomes, such as ICU and hospital length-of-stay, duration of mechanical ventilation and lowers the incidence of atrial fibrillation. Due to missing reports on organ dysfunction, this meta-analysis cannot answer the question, if vitamin C can improve single- or multiorgan function after cardiac surgery. View Full-Text
Keywords: cardiac surgery; oxidative stress; reperfusion injury; antioxidant; vitamin; ascorbic acid; organ dysfunction; systematic review; meta-analysis cardiac surgery; oxidative stress; reperfusion injury; antioxidant; vitamin; ascorbic acid; organ dysfunction; systematic review; meta-analysis
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Hill, A.; Clasen, K.C.; Wendt, S.; Majoros, Á.G.; Stoppe, C.; Adhikari, N.K.J.; Heyland, D.K.; Benstoem, C. Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Nutrients 2019, 11, 2103.

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