Elsevier

Resuscitation

Volume 156, November 2020, Pages 190-193
Resuscitation

Short paper
Vitamin C levels amongst initial survivors of out of hospital cardiac arrest

https://doi.org/10.1016/j.resuscitation.2020.09.005Get rights and content

Abstract

Introduction

Vitamin C deficiency has been described in patients with sepsis. The post-cardiac arrest syndrome shares similarities to sepsis, however vitamin C levels in post-arrest patients have been incompletely characterized. We assessed vitamin C levels in a post-arrest population.

Methods

This was a retrospective observational study at a tertiary care center. A convenience sample of post-arrest, sepsis, and healthy control patients was selected from prior studies. Vitamin C levels were measured from samples obtained within 6-h of emergency department admission. A subset of cardiac arrest patients had vitamin C levels additionally measured 24-h later.

Results

A total of 84 patients (34 healthy controls, 25 post-arrest, and 25 septic patients) were included. The median baseline vitamin C level in cardiac arrest patients was 0.33 mg/dL (0.05–0.83), as compared to 0.91 mg/dL (0.69–1.48) in the healthy control group (p < 0.01) and 0.28 mg/dL (0.11–0.59) in the septic group (p = 0.36). Vitamin C levels for cardiac arrest patients fell between the two time points, but the change was not statistically significant (median decrease 0.26 mg/dL, p = 0.08).

Conclusions

Serum vitamin C levels were lower in post-arrest patients compared to controls and were similar to patients with sepsis. Future studies of vitamin C levels and supplementation following cardiac arrest may be warranted.

Introduction

Vitamin C has several functions. In addition to serving as an anti-oxidant and co-factor in catecholamine synthesis, it also has anti-inflammatory and immune-modulating properties.1, 2 Vitamin C deficiency has been described in sepsis.3, 4, 5 and there is evidence that supplementation may help attenuate organ injury and improve mortality in sepsis victims.6, 7, 8, 9

The post-cardiac arrest syndrome is characterized by brain injury, myocardial dysfunction, and systemic ischemia-reperfusion injury. The post-arrest systemic pathophysiologic cascade shares several features in common with sepsis such as mitochondrial dysfunction, generalized activation of coagulation and immunologic pathways, with resultant multi-organ failure and high rates of morbidity.10, 11 To date, there has been a paucity of studies exploring vitamin C levels in post-arrest populations.

In this study we hypothesized that post-arrest patients would have significantly lower vitamin C levels than healthy controls and similar levels to septic patients.

Section snippets

Study design

This was a single center, retrospective, observational study performed at an academic tertiary care center. Vitamin C levels were measured in stored blood samples collected during two previously completed, multicenter prospective studies. The original studies, including blood collection and analysis plans, were approved by the Beth Israel Deaconess Medical Center Committee on Clinical Investigation (CCI).

Data collection

Blood samples from cardiac arrest victims were collected during the Characterization of

Cohort characteristics

There were 84 patients who had serum samples available for testing. Of these, 34 were healthy controls, 25 were post-cardiac arrest patients, and 25 were septic patients. Demographic data, comorbidities, the worst serum lactate over the first 24-h after enrollment, and in-hospitality mortality for these patients can be found in Table 1.

Vitamin C levels at time 0

The median baseline vitamin C level in cardiac arrest patients was 0.33 mg/dL (0.05–0.83), as compared to 0.91 mg/dL (0.69–1.48) in the healthy control group and

Discussion

In this study, serum vitamin C levels were lower in patients post-cardiac arrest as compared to healthy controls and were similar to those in septic patients. Over the next 24 h, vitamin C levels in post-arrest patients trended downwards. Aside from an abstract from Grooth et al. in 2014,14 we believe this is the first study to describe vitamin C levels in human subjects post-cardiac arrest.

Multiple studies have identified vitamin C deficiency in sepsis and septic shock patients.5, 7, 14 While

Conclusions

Vitamin C levels were lower in patients post-cardiac arrest compared to controls and were similar to patients with sepsis. These levels appeared to continue to decline over the first 24 h after admission. Future studies of vitamin C supplementation post-cardiac arrest may be warranted.

Conflicts of interest

None.

Source of funding

This study was supported in part by a grant from the Open Philanthropy Project. Dr. Moskowitz is supported by a grant from the National Institutes of Health (K23GM128005-01). Dr. Donnino is supported by a grant from the National Heart, Lung, and Blood Institute (K24HL12701).

In submitting this manuscript, we declare that all authors noted above have made substantial contribution to the design of the study, acquisition and analysis of the data, both drafting and revising the article critically,

Acknowledgements

Special thanks to the Center for Resuscitation Science at Beth Israel Deaconess Medical Center for their contributions to this manuscript

References (19)

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