Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes.
Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes.
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DOI：
10.1186/s13054-017-1891-y
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发表时间：
2017-12-11
期刊：
影响因子：
--
通讯作者：
Shaw GM
中科院分区：
文献类型：
--
作者：
Carr AC;Rosengrave PC;Bayer S;Chambers S;Mehrtens J;Shaw GM
维生素C是一种人体无法合成或储存的必需的水溶性营养物质。它是一种有效的抗氧化剂，具有抗炎和免疫支持作用。先前的研究表明，危重病人体内的维生素C水平已经耗尽。在这项研究中，我们评估了危重病患者的血浆维生素C浓度与感染状态(感染性休克或非感染性休克)和炎症水平(C反应蛋白浓度)的关系。还评估了相对于每天肠内和肠外摄入量的维生素C状况，以确定标准重症监护病房(ICU)的营养支持是否足以满足危重患者的维生素C需求。从克赖斯特彻奇医院重症监护病房招募了44名危重病人(24名感染性休克，17名非感染性休克，3名未分类)。我们在4天内每天测量血浆维生素C和一种促炎生物标记物(C反应蛋白)的浓度，并计算患者从他们接受的肠内或完全肠外营养中每天的维生素C摄入量。我们使用混合效应统计模型比较了感染性休克和非感染性休克患者4天内的血浆维生素C和C反应蛋白浓度，并使用四参数对数Logistic响应模型比较了危重患者的维生素C状况和已知的维生素C生物利用度数据。总体而言，危重病患者表现为维生素C缺乏(即 23和μ摩尔/L)，平均血浆维生素C浓度为17.8 ± 8.7μ摩尔/L；其中三分之一患有维生素C缺乏(即<； 11和μ摩尔/L)。维生素C缺乏症患者的炎症水平升高(C-反应蛋白水平；P <； 0.05)。感染性休克患者的维生素C浓度低于非感染性休克患者，而C反应蛋白浓度高于非感染性休克患者(P <； 0.05)。近40%的感染性休克患者缺乏维生素C，而非感染性休克患者的这一比例为25%。尽管接受了肠内和/或肠外营养治疗的推荐摄入量(平均每天125毫克)，但这些低维生素C水平仍然很明显。尽管接受了标准的ICU营养，危重患者的维生素C浓度仍然很低。感染性休克患者与非感染性休克患者相比，维生素C水平显著降低，这可能是由于感染性休克时观察到的炎症反应增强导致代谢增加所致。
Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this study we have assessed plasma vitamin C concentrations in critically ill patients relative to infection status (septic shock or non-septic) and level of inflammation (C-reactive protein concentrations). Vitamin C status was also assessed relative to daily enteral and parenteral intakes to determine if standard intensive care unit (ICU) nutritional support is adequate to meet the vitamin C needs of critically ill patients. Forty-four critically ill patients (24 with septic shock, 17 non-septic, 3 uncategorised) were recruited from the Christchurch Hospital Intensive Care Unit. We measured concentrations of plasma vitamin C and a pro-inflammatory biomarker (C-reactive protein) daily over 4 days and calculated patients’ daily vitamin C intake from the enteral or total parenteral nutrition they received. We compared plasma vitamin C and C-reactive protein concentrations between septic shock and non-septic patients over 4 days using a mixed effects statistical model, and we compared the vitamin C status of the critically ill patients with known vitamin C bioavailability data using a four-parameter log-logistic response model. Overall, the critically ill patients exhibited hypovitaminosis C (i.e., < 23 μmol/L), with a mean plasma vitamin C concentration of 17.8 ± 8.7 μmol/L; of these, one-third had vitamin C deficiency (i.e., < 11 μmol/L). Patients with hypovitaminosis C had elevated inflammation (C-reactive protein levels; P < 0.05). The patients with septic shock had lower vitamin C concentrations and higher C-reactive protein concentrations than the non-septic patients (P < 0.05). Nearly 40% of the septic shock patients were deficient in vitamin C, compared with 25% of the non-septic patients. These low vitamin C levels were apparent despite receiving recommended intakes via enteral and/or parenteral nutritional therapy (mean 125 mg/d). Critically ill patients have low vitamin C concentrations despite receiving standard ICU nutrition. Septic shock patients have significantly depleted vitamin C levels compared with non-septic patients, likely resulting from increased metabolism due to the enhanced inflammatory response observed in septic shock.
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DOI：
10.1186/s13054-015-1131-2
发表时间：
2015-11-27
期刊：
Critical care (London, England)
影响因子：
--
作者：
Carr AC;Shaw GM;Fowler AA;Natarajan R
通讯作者：
Natarajan R
影响因子：
5.9
作者：
Carr AC;Bozonet SM;Vissers MC
通讯作者：
Vissers MC
影响因子：
2.5
作者：
Carr, Anitra C;Pullar, Juliet M;Moran, Stephanie;Vissers, Margreet C M
通讯作者：
Vissers, Margreet C M
DOI：
10.3181/00379727-88-21659
发表时间：
1955-01-01
影响因子：
--
作者：
CHAKRABARTI, B;BANERJEE, S
通讯作者：
BANERJEE, S
影响因子：
7.1
作者：
DHARIWAL, KR;HARTZELL, WO;LEVINE, M
通讯作者：
LEVINE, M