The aim of this study was to examine whether vitamin C reduced mortality when adjutant therapy of patients with septic shock and severe sepsis compared with placebo by meta-analysis. Eligible trials were identified fr...The aim of this study was to examine whether vitamin C reduced mortality when adjutant therapy of patients with septic shock and severe sepsis compared with placebo by meta-analysis. Eligible trials were identified from Pubmed, Embase, Ovid, and the Cochrane database. Four randomized controlled trials (RCT) and two retrospective studies were published between 2000 and 2017 met the inclusion criteria and suitable for meta-analysis. The data were analyzed with randomized-effects or fixed-effects models using Review Manager Version 5.3. Four randomized studies with a total of 109 participants were suitable for meta-analysis. The heterogeneity was assessed by calculating the Q and I2 methods. A random-effects approach instead of a fixed-effects analysis was undertaken if I2 > 50%. Adjuvant vitamin C did not associate with a reduction in mortality as compared with placebo, it is occurred similarly in both RCT studies and retrospective studies. However, high doses of vitamin C (>50 mg/kg/day) significant reduced the mortality rate of severe sepsis patients. And administration of high doses of vitamin C to therapy severe sepsis did not significantly reduce the ICU length of stay. The results suggested a trend toward reducing mortality in severe sepsis and septic shock patients’ adjuvant with vitamin C. Further multicenter large randomized controlled trials are necessary to determine the potential benefits of vitamin C in patients with severe sepsis and septic shock.展开更多
Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis r...Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis remains high,despite significant interventions and guidelines.It has been known for decades that patients with sepsis have reduced levels of antioxidants,most notably vitamin C.Furthermore,experimental data has demonstrated multiple beneficial effects of vitamin C in sepsis.In addition,corticosteroids and thiamine may have synergistic biological effects together with vitamin C.Preliminary data suggests that therapy with hydrocortisone,ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of lives.However,this intervention has met with much resistance and has not been widely adopted.Ultimately,we await the final jury verdict on this simple,safe and cheap intervention.展开更多
Background Valproic acid （VPA） improves early survival and organ function in a highly lethal poly-trauma and hemorrhagic shock model or other severe insults. We assessed whether VPA could improve organ function in a...Background Valproic acid （VPA） improves early survival and organ function in a highly lethal poly-trauma and hemorrhagic shock model or other severe insults. We assessed whether VPA could improve organ function in a rat model of septic shock and illustrated the possible mechanisms. Methods Forty Sprague-Dawley rats were randomly assigned to four groups （n=-10）： control group, VPA group, LPS group, and LPS＋VPA group. Lipopolysaccharide （LPS） （10 mg/kg） was injected intravenously to replicate the experimental model of septic shock. Rats were treated with VPA （300 mg/kg, i.v.） or saline. Six hours after LPS injection, blood was sampled for gas analysis, measurement of serum alanine aminotransferase, aspartate aminotransferase, urine nitrogen, creatinine and tumor necrosis factor-alpha. Lung, liver and kidney were collected for histopathological assessment. In addition, myeloperoxidase activity and tumor necrosis factor-α in pulmonary tissue were measured. Acetylation of histone H3 in lung was also evaluated by Western blotting. Results LPS resulted in a significant decrease in PaO2, which was increased by VPA administration followed LPS injection. In addition, LPS also induced an increase in the serum levels of alanine aminotransferase, aspartate aminotransferase, urine nitrogen, creatinine, and tumor necrosis factor-alpha. However, these increases were attenuated in the LPS＋VPA group. The lungs, liver and kidneys from the LPS group were significantly damaged compared with the control group. However, the damage was attenuated in the LPS＋VPA group. Myeloperoxidase activity and tumor necrosis factor-alpha levels in pulmonary tissue increased significantly in the LPS group compared with the control group. These increases were significantly inhibited in the LPS＋VPA group. Acetylation of histone H3 in lung tissue in the LPS group was inhibited compared with the control. However, the level of acetylation of histone H3 in the LPS＋VPA group was markedly elevated in contrast to the LPS group. Conclusions Treatment with VPA can attenuate multiple organ damage caused by LPS induced septic shock. Our data also suggest that the beneficial effects are in part due to the decrease in inflammatory cytokines and restoration of normal acetylation homeostasis.展开更多
文摘The aim of this study was to examine whether vitamin C reduced mortality when adjutant therapy of patients with septic shock and severe sepsis compared with placebo by meta-analysis. Eligible trials were identified from Pubmed, Embase, Ovid, and the Cochrane database. Four randomized controlled trials (RCT) and two retrospective studies were published between 2000 and 2017 met the inclusion criteria and suitable for meta-analysis. The data were analyzed with randomized-effects or fixed-effects models using Review Manager Version 5.3. Four randomized studies with a total of 109 participants were suitable for meta-analysis. The heterogeneity was assessed by calculating the Q and I2 methods. A random-effects approach instead of a fixed-effects analysis was undertaken if I2 > 50%. Adjuvant vitamin C did not associate with a reduction in mortality as compared with placebo, it is occurred similarly in both RCT studies and retrospective studies. However, high doses of vitamin C (>50 mg/kg/day) significant reduced the mortality rate of severe sepsis patients. And administration of high doses of vitamin C to therapy severe sepsis did not significantly reduce the ICU length of stay. The results suggested a trend toward reducing mortality in severe sepsis and septic shock patients’ adjuvant with vitamin C. Further multicenter large randomized controlled trials are necessary to determine the potential benefits of vitamin C in patients with severe sepsis and septic shock.
文摘Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis remains high,despite significant interventions and guidelines.It has been known for decades that patients with sepsis have reduced levels of antioxidants,most notably vitamin C.Furthermore,experimental data has demonstrated multiple beneficial effects of vitamin C in sepsis.In addition,corticosteroids and thiamine may have synergistic biological effects together with vitamin C.Preliminary data suggests that therapy with hydrocortisone,ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of lives.However,this intervention has met with much resistance and has not been widely adopted.Ultimately,we await the final jury verdict on this simple,safe and cheap intervention.
文摘目的分析创伤急诊失血性休克患者格拉斯哥昏迷评分(Glasgowcoma score,GCS)、血乳酸(lactic acid,Lac)与输血量的相关性及对患者预后的预测价值。方法回顾性收集2021年3月至2023年5月于金华市人民医院急诊医学中心诊治且完成随访的128例失血性休克患者的临床资料,按预后情况分为预后良好组(n=106)和预后不良组(n=22),比较两组患者的一般资料及GCS评分、Lac水平、输血量。采用Cox回归模型分析创伤急诊失血性休克患者预后情况的影响因素。建立受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析GCS评分、Lac水平、输血量对创伤急诊失血性休克患者预后的预测价值。结果128例患者中预后不良22例,占比17.19%。预后不良组患者的初始24h输血量及Lac、白细胞(whitebloodcell,WBC)水平高于预后良好组,入院GCS评分、血红蛋白(hemoglobin,Hb)水平低于预后良好组,差异有统计学意义(P<0.05)。Pearson相关分析显示初始24h输血量与入院GCS评分、入院Hb水平呈负相关(P<0.05),与入院Lac水平呈正相关(P<0.05)。初始24h输血量、入院GCS评分及入院Lac、Hb水平是影响创伤急诊失血性休克患者预后的独立危险因素(P<0.05)。初始24h输血量、入院GCS评分、入院Lac、入院Hb水平及联合检测的曲线下面积(area under the curve,AUC)分别为0.722、0.872、0.881、0.798、0.931,敏感度分别为68.2%、76.6%、85.7%、75.7%、88.8%,特异性分别为70.8%、81.0%、78.5%、81.0%、85.7%。成对Z检验显示,联合检测的AUC高于单个指标检测,且敏感度和特异性均为最优(P<0.05)。结论初始24h输血量、入院GCS评分及入院Lac、Hb水平均是影响创伤急诊失血性休克患者预后不良的独立危险因素,且4项指标联合检测的效能价值最高。
基金This work was Supported by a grant from the National Natural Science Foundation of China （No. 30930089）.
文摘Background Valproic acid （VPA） improves early survival and organ function in a highly lethal poly-trauma and hemorrhagic shock model or other severe insults. We assessed whether VPA could improve organ function in a rat model of septic shock and illustrated the possible mechanisms. Methods Forty Sprague-Dawley rats were randomly assigned to four groups （n=-10）： control group, VPA group, LPS group, and LPS＋VPA group. Lipopolysaccharide （LPS） （10 mg/kg） was injected intravenously to replicate the experimental model of septic shock. Rats were treated with VPA （300 mg/kg, i.v.） or saline. Six hours after LPS injection, blood was sampled for gas analysis, measurement of serum alanine aminotransferase, aspartate aminotransferase, urine nitrogen, creatinine and tumor necrosis factor-alpha. Lung, liver and kidney were collected for histopathological assessment. In addition, myeloperoxidase activity and tumor necrosis factor-α in pulmonary tissue were measured. Acetylation of histone H3 in lung was also evaluated by Western blotting. Results LPS resulted in a significant decrease in PaO2, which was increased by VPA administration followed LPS injection. In addition, LPS also induced an increase in the serum levels of alanine aminotransferase, aspartate aminotransferase, urine nitrogen, creatinine, and tumor necrosis factor-alpha. However, these increases were attenuated in the LPS＋VPA group. The lungs, liver and kidneys from the LPS group were significantly damaged compared with the control group. However, the damage was attenuated in the LPS＋VPA group. Myeloperoxidase activity and tumor necrosis factor-alpha levels in pulmonary tissue increased significantly in the LPS group compared with the control group. These increases were significantly inhibited in the LPS＋VPA group. Acetylation of histone H3 in lung tissue in the LPS group was inhibited compared with the control. However, the level of acetylation of histone H3 in the LPS＋VPA group was markedly elevated in contrast to the LPS group. Conclusions Treatment with VPA can attenuate multiple organ damage caused by LPS induced septic shock. Our data also suggest that the beneficial effects are in part due to the decrease in inflammatory cytokines and restoration of normal acetylation homeostasis.
