Role of ascorbic acid infusion in critically ill patients with transfusion-related acute lung injury

Amira B Kassem, Islam Ahmed, Gamal Omran, Mohamed Megahed, Tamer Habib, Amira B Kassem, Islam Ahmed, Gamal Omran, Mohamed Megahed, Tamer Habib

Abstract

Introduction: In critically ill patients, transfusion-related acute lung injury (TRALI) remains the leading cause of transfusion-related fatalities in critical care settings and is associated with inflammation and oxidative stress state. Recent research raised the potential efficacy of high-dose intravenous ascorbic acid (VC) in critically ill patients.

Objective: The aim of this trial was to investigate the effect of high-dose intravenous VC as a targeted therapy for TRALI in terms of serum proinflammatory (interleukin [IL]-8, IL-1β, C-reactive protein), anti-inflammatory (IL-10), oxidative stress (superoxide dismutase, malondialdehyde) markers, and plasma VC levels. Secondary outcomes were oxygenation (PaO2 /FiO2 ratio), vasopressor use, duration of mechanical ventilation, ICU length of stay, 7-day mortality and 28-day mortality.

Methods: Eighty critically ill patients with TRALI (n = 80) were randomized to receive 2.5 g/6 h intravenous vitamin C for 96 hours (ASTRALI group) or placebo. Patients were followed up to measure the outcomes initially (T0) and at the end of treatment (T96).

Results: When compared to the control group, the ASTRALI group at T96 showed significantly higher median of IL-10 (31.6 ± 25.8 vs 17.7 ± 12.0 pg/mL, P < .0001) levels and superoxide dismutase (12 876 ± 4627 U/L vs 5895 ± 6632 U/L, P < .0001) activities, and lower median C-reactive protein (76 ± 50 vs 89 ± 56 mg/L, P = .033), IL-8 (11.8 ± 7.3 vs 35.5 ± 19.8 pg/mL, P < .0001) and malondialdehyde (0.197 ± 0.034 vs 0.234 ± 0.074 μM/L, P = .002) levels.

Conclusion: High-dose ascorbic acid was associated with significantly reduced oxidative stress, reduced pro-inflammatory markers except IL-1β, elevated anti-inflammatory marker and elevated plasma VC levels.

Trial registration: ClinicalTrials.gov NCT04153487.

Keywords: TRALI; ascorbic acid; critical care; inflammation; lung injury; oxidative stress.

© 2021 British Pharmacological Society.

References

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