Reanalysis of the Effect of Vitamin C on Mortality in the CITRIS-ALI Trial: Important Findings Dismissed in the Trial Report.

Plain Language Summary

This article is a re-analysis of data from a clinical trial into the effects of intravenous vitamin C on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure. The authors of this critique argue that the way the results were presented in the original paper is misleading. In particular, they criticise the focus on biomarkers, rather than important clinical outcomes. Apparently, whilst many of the biomarkers showed no significant improvements, vitamin C significantly improved three out of four clinically important outcomes: ICU-free days, hospital-free days, and mortality, but not ventilator-free days. The authors also point out a number of flaws in study design, for example, mortality follow-up was 28 days although vitamin C was only given for four days, and apparently data showed significantly better outcomes whilst patients received vitamin C. Overall, the authors of this critique conclude that the effect of vitamin C on mortality in this study is not equal to placebo as suggested by the authors of the original paper, but that vitamin C causes an 81% reduction in mortality which is similar to that shown in other clinical studies.