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Prognostic value of T-lymphocyte subsets, lymphocyte-to-high-density lipoprotein ratio, interleukin 6, C-reactive protein and procalcitonin in patients with septic shock and effects of vitamin C on patients with septic shock.

  • 2026-01-01
  • Pakistan journal of pharmaceutical sciences 39(1)
    • Yuyu Lu
    • Ling Wu
    • Lingling Nie

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 110
Population
110 patients (January 2023-March 2024), stratified by 28-day outcome into survival (n=90) and death (n=20) groups
Methods
Patients were randomized to control (hydrocortisone) or observation (hydrocortisone with vitamin C) group
Duration
28-day outcome
  • Large Human Trial

Background

Septic shock remains a critical condition with high mortality, necessitating reliable prognostic biomarkers and effective adjunct therapies.

Objectives

This study explored prognostic biomarkers and the effect of vitamin C in septic shock.

Methods

This study analyzed 110 patients (January 2023-March 2024), stratified by 28-day outcome into survival (n=90) and death (n=20) groups. Compared to survivors, the death group exhibited significantly lower lymphocyte-to-high-density lipoprotein ratio (LHR), CD3+, CD3+CD4+, CD4+/CD8+ and higher interleukin 6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), CD3+CD8+.

Results

The receiver operating characteristic analysis showed the combination of LHR, IL-6, CRP, PCT and CD4+/CD8+ predicted death best [area under the receiver operating characteristic curve (AUC) =0.960], outperforming single markers. Patients were randomized to control (hydrocortisone) or observation (hydrocortisone with vitamin C) group. Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

Conclusion

The combination of LHR, IL-6, CRP, PCT and CD4+/CD8+ has prognostic value. Vitamin C adjunct therapy significantly enhances hemodynamic improvement, reduces inflammation, lowers SOFA scores and improves prognosis in septic shock patients.

Research Insights

  • Vitamin C→Improved Mean Arterial Pressure

    Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin C→Reduced Central Venous Pressure

    Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin C→Reduced Heart Rate

    Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin C→Reduced Interleukin-6 Levels

    Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin C→Reduced Procalcitonin Level

    Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin C→Reduced Sequential Organ Failure Assessment Score

    Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin C→Reduced Tumor Necrosis Factor Alpha

    Post-treatment, both groups showed improved mean arterial pressure (MAP), central venous pressure (CVP) (increased), heart rate (HR) (decreased) and reduced PCT, tumor necrosis factor-α (TNF-α), IL-6 and Sequential Organ Failure Assessment (SOFA) score; however, improvements were significantly greater in the vitamin C group.

    Effect
    Beneficial
    Effect size
    Moderate
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