Efficacy and safety of vitamin C supplementation in the treatment of community-acquired pneumonia: a systematic review and meta-analysis with trial sequential analysis.

2024-05-24
Scientific reports 14(1)
- Yogesh Sharma
- Subodha Sumanadasa
- Rashmi Shahi
- Richard Woodman
- Arduino A Mangoni
- Shailesh Bihari
- Campbell Thompson

PubMed: 38783029
DOI: 10.1038/s41598-024-62571-5

Study Design

Type: Meta-Analysis
Population: adults undergoing treatment for CAP
Methods: Systematic review and meta-analysis of six randomized-controlled-trials identified through comprehensive database search from inception to 17 November 2023

Rigorous Journal

Community-acquired pneumonia (CAP) poses a significant global health challenge, prompting exploration of innovative treatments. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of vitamin C supplementation in adults undergoing treatment for CAP. A comprehensive search of the MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and Clinical Trials.gov databases from inception to 17 November 2023 identified six randomized-controlled-trials (RCTs) meeting inclusion criteria. The primary outcome analysis revealed a non-significant trend towards reduced overall mortality in the vitamin C group compared to controls (RR 0.51; 95% CI 0.24 to 1.09; p = 0.052; I² = 0; p = 0.65). Sensitivity analysis, excluding corona-virus-disease 2019 (COVID-19) studies and considering the route of vitamin C administration, confirmed this trend. Secondary outcomes, including hospital length-of-stay (LOS), intensive-care-unit (ICU) LOS, and mechanical ventilation, exhibited mixed results. Notably, heterogeneity and publication bias were observed in hospital LOS analysis, necessitating cautious interpretation. Adverse effects were minimal, with isolated incidents of nausea, vomiting, hypotension, and tachycardia reported. This meta-analysis suggests potential benefits of vitamin C supplementation in CAP treatment. However, inconclusive findings and methodological limitations warrants cautious interpretation, emphasising the urgency for high-quality trials to elucidate the true impact of vitamin C supplementation in CAP management.

Research Insights

Vitamin C→Reduced Intensive Care Unit Length of Stay
Secondary outcomes, including hospital length-of-stay (LOS), intensive-care-unit (ICU) LOS, and mechanical ventilation, exhibited mixed results.
Effect
Neutral
Effect size
Small
Vitamin C→Reduced Length of Hospital Stay
Secondary outcomes, including hospital length-of-stay (LOS), intensive-care-unit (ICU) LOS, and mechanical ventilation, exhibited mixed results. Notably, heterogeneity and publication bias were observed in hospital LOS analysis, necessitating cautious interpretation.
Effect
Neutral
Effect size
Small
Vitamin C→Reduced Mechanical Ventilation Requirement
Secondary outcomes, including hospital length-of-stay (LOS), intensive-care-unit (ICU) LOS, and mechanical ventilation, exhibited mixed results.
Effect
Neutral
Effect size
Small
Vitamin C→Reduced Overall Mortality
The primary outcome analysis revealed a non-significant trend towards reduced overall mortality in the vitamin C group compared to controls (RR 0.51; 95% CI 0.24 to 1.09; p = 0.052; I² = 0; p = 0.65).
Effect
Neutral
Effect size
Large

Adverse Events Reported

Vitamin C→hypotension
Adverse effects were minimal, with isolated incidents of nausea, vomiting, hypotension, and tachycardia reported.
Finding
Reported
Vitamin C→nausea
Adverse effects were minimal, with isolated incidents of nausea, vomiting, hypotension, and tachycardia reported.
Finding
Reported
Vitamin C→tachycardia
Adverse effects were minimal, with isolated incidents of nausea, vomiting, hypotension, and tachycardia reported.
Finding
Reported
Vitamin C→vomiting
Adverse effects were minimal, with isolated incidents of nausea, vomiting, hypotension, and tachycardia reported.
Finding
Reported