Role of Vitamin C for the Treatment of COVID-19: An Umbrella Review
-
Kavous Shahsavarinia
,
Shaghayegh Musazadeh
,
Morteza Ghojazadeh
,
Nooshin Milanchian
,
Maryam Soleimanpour
,
Hassan Soleimanpour
Abstract
Background: Coronavirus disease 2019 (COVID-19) is an infectious illness resulting from the SARS-CoV-2 virus. The immune system overactivation triggered by this virus results in multiple organ damage. This infection has the potential to cause acute respiratory distress syndrome and may progress to respiratory failure, both of which can be life-threatening. Vitamin C is proposed as a possible treatment for immune system overactivation due to its antioxidant properties.
Methods: This umbrella review seeks to evaluate the effectiveness of vitamin C in the management of COVID-19 infection. To identify pertinent literature, we conducted searches across Embase, PubMed, Scopus, and Web of Science databases. Our analysis incorporated eight systematic reviews and meta-analyses that examined the impact of vitamin C on COVID-19 treatment outcomes.
Results: Our findings revealed that the odds ratio (OR) of mortality in the vitamin C group is 0.55 (0.48-0.63). The duration of hospitalization did not differ between the groups and the need for mechanical ventilation in both groups. This umbrella review discusses the use of vitamin C in COVID-19 patients, highlighting its potential to reduce mortality rates. While the duration and dose of treatment vary There was no notable distinction observed between the vitamin C group and the control groups in hospital length, ICU stay, or mechanical ventilation days.
Conclusion: The study suggests further research to determine its effectiveness in reducing mortality rates and suggests larger studies with a more specific protocol.
[1] Sethi BA, Sethi A, Ali S, Aamir HS. Impact of Coronavirus disease (COVID-19) pandemic on health professionals. Pak J Med Sci. 2020;36(Covid19-s4):S6-s11.
[2] Ashmore P, Sherwood E. An overview of COVID-19 global epidemiology and discussion of potential drivers of variable global pandemic impacts. J Antimicrob Chemother. 2023;78(Suppl 2):ii2-ii11.
[3] Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613(7942):130-7.
[4] Montazersaheb S, Hosseiniyan Khatibi SM, Hejazi MS, Tarhriz V, Farjami A, Ghasemian Sorbeni F, et al. COVID-19 infection: an overview on cytokine storm and related interventions. Virology Journal. 2022;19(1):92.
[5] Wu J. Tackle the free radicals damage in COVID-19. Nitric Oxide. 2020;102:39-41.
[6] Thakur A, Sharma V, Averbek S, Liang L, Pandya N, Kumar G, et al. Immune landscape and redox imbalance during neurological disorders in COVID-19. Cell Death & Disease. 2023;14(9):593.
[7] Bagi HM, Soleimanpour M, Abdollahi F, Soleimanpour H. Evaluation of clinical outcomes of patients with mild symptoms of coronavirus disease 2019 (COVID-19) discharged from the emergency department. PLoS One. 2021;16(10):e0258697.
[8] Tekantapeh ST, Nader ND, Ghojazadeh M, Fereidouni F, Soleimanpour H. Prone positioning effect on tracheal intubation rate, mortality and oxygenation parameters in awake non-intubated severe COVID-19-induced respiratory failure: a review of reviews. Eur J Med Res. 2024;29(1):63.
[9] Tahsini Tekantapeh S, Ghojazadeh M, Ghamari AA, Mohammadi A, Soleimanpour H. Therapeutic and anti-inflammatory effects of baricitinib on mortality, ICU transfer, clinical improvement, and CRS-related laboratory parameters of hospitalized patients with moderate to severe COVID-19 pneumonia: a systematic review and meta-analysis. Expert Rev Respir Med. 2022;16(10):1109-32.
[10] Mousavi S, Bereswill S, Heimesaat MM. Immunomodulatory and antimicrobial effects of vitamin C. European Journal of Microbiology and Immunology EuJMI. 2019;9(3):73-9.
[11] Cai Y, Li Y-F, Tang L-P, Tsoi B, Chen M, Chen H, et al. A New Mechanism of Vitamin C Effects on A/FM/1/47(H1N1) Virus-Induced Pneumonia in Restraint-Stressed Mice. BioMed Research International. 2015;2015(1):675149.
[12] Mahmoodpoor A, Shadvar K, Sanaie S, Hadipoor MR, Pourmoghaddam MA, Saghaleini SH. Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit: a preliminary study. BMC Infectious Diseases. 2021;21(1):616.
[13] Fowler AA, Syed AA, Knowlson S, Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. Journal of translational medicine. 2014;12:1-10.
[14] Lee SI, Lim CM, Koh Y, Huh JW, Lee JS, Hong SB. The effectiveness of vitamin C for patients with severe viral pneumonia in respiratory failure. J Thorac Dis. 2021;13(2):632-41.
[15] Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017;151(6):1229-38.
[16] Ao G, Li J, Yuan Y, Wang Y, Nasr B, Bao M, et al. Intravenous vitamin C use and risk of severity and mortality in COVID-19: A systematic review and meta-analysis. Nutr Clin Pract. 2022;37(2):274-81.
[17] Gavrielatou E, Xourgia E, Xixi NA, Mantelou AG, Ischaki E, Kanavou A, et al. Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis. Frontiers in Medicine. 2022;9.
[18] Kow CS, Hasan SS, Ramachandram DS. The effect of vitamin C on the risk of mortality in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials. Inflammopharmacology. 2023;31(6):3357-62.
[19] Kwak SG, Choo YJ, Chang MC. The effectiveness of high-dose intravenous vitamin C for patients with coronavirus disease 2019: A systematic review and meta-analysis. Complement Ther Med. 2022;64:102797.
[20] Olczak-Pruc M, Świeczkowski D, Ladny J, Pruc M, Juárez-Vela R, Rafique Z, et al. Vitamin C Supplementation for the Treatment of COVID-19: A Systematic Review and Meta-Analysis. Nutrients. 2022;2022:4217.
[21] Rawat D, Roy A, Maitra S, Gulati A, Khanna P, Baidya DK. Vitamin C and COVID-19 treatment: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndr. 2021;15(6):102324.
[22] Vollbracht C, Kraft K. Feasibility of Vitamin C in the Treatment of Post Viral Fatigue with Focus on Long COVID, Based on a Systematic Review of IV Vitamin C on Fatigue. Nutrients. 2021;13(4).
[23] Xu C, Yi T, Tan S, Xu H, Hu Y, Ma J, et al. Association of Oral or Intravenous Vitamin C Supplementation with Mortality: A Systematic Review and Meta-Analysis. Nutrients. 2023;15(8).
[24] Lykkesfeldt J, Tveden-Nyborg P. The Pharmacokinetics of Vitamin C. Nutrients. 2019;11(10).
[25] Upadhya S, Rehman J, Malik AB, Chen S. Mechanisms of Lung Injury Induced by SARS-CoV-2 Infection. Physiology (Bethesda). 2022;37(2):88-100.
[26] Alimohamadi Y, Yekta EM, Sepandi M, Sharafoddin M, Arshadi M, Hesari E. Hospital length of stay for COVID-19 patients: a systematic review and meta-analysis. Multidiscip Respir Med. 2022;17(1):856.
[27] Wunsch H. Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology. Am J Respir Crit Care Med. 2020;202(1):1-4.
[28] Balafar M, Mahmoodpoor A, Arjmandi H, Khelejani AM, Soleimanpour H. High-Dose Vitamin C in the Treatment of Covid-19 Patients in Intensive Care Unit; A Letter to the Editor. Archives of Academic Emergency Medicine. 2024;12(1):e41.
[29] Sinnberg T, Lichtensteiger C, Hill-Mündel K, Leischner C, Niessner H, Busch C, et al. Vitamin C Deficiency in Blood Samples of COVID-19 Patients. Antioxidants (Basel). 2022;11(8).
[30] Chiscano-Camón L, Ruiz-Rodriguez JC, Plata-Menchaca EP, Martin L, Bajaña I, Martin-Rodríguez C, et al. Vitamin C deficiency in critically ill COVID-19 patients admitted to intensive care unit. Frontiers in Medicine. 2023;10.
[31] Fisher BJ, Kraskauskas D, Martin EJ, Farkas D, Wegelin JA, Brophy D, et al. Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid. Am J Physiol Lung Cell Mol Physiol. 2012;303(1):L20-32.
[32] Soleimanpour H. The magical role of vitamin C on adrenal insufficiency subsequent to etomidate administration: ongoing challenges in the management of trauma patients. Int J Drug Res Clin. 2023;1:e1.
[33] Panahi JR, Paknezhad SP, Vahedi A, Shahsavarinia K, Laleh MR, Soleimanpour H. Effect of vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients: a randomized clinical trial. BMC Anesthesiol. 2023;23(1):104.
[34] Shahsavarinia K, Ghojazadeh M, Ghabousian A, Hatefnia F, Soleimanpour M, Soleimanpour H. An Umbrella Review of Clinical Efficacy and Adverse Cardiac Events Associated with Hydroxychloroquine or Chloroquine with or Without Azithromycin in Patients with COVID-19. Anesth Pain Med. 2021;11(4):e115827.
[2] Ashmore P, Sherwood E. An overview of COVID-19 global epidemiology and discussion of potential drivers of variable global pandemic impacts. J Antimicrob Chemother. 2023;78(Suppl 2):ii2-ii11.
[3] Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613(7942):130-7.
[4] Montazersaheb S, Hosseiniyan Khatibi SM, Hejazi MS, Tarhriz V, Farjami A, Ghasemian Sorbeni F, et al. COVID-19 infection: an overview on cytokine storm and related interventions. Virology Journal. 2022;19(1):92.
[5] Wu J. Tackle the free radicals damage in COVID-19. Nitric Oxide. 2020;102:39-41.
[6] Thakur A, Sharma V, Averbek S, Liang L, Pandya N, Kumar G, et al. Immune landscape and redox imbalance during neurological disorders in COVID-19. Cell Death & Disease. 2023;14(9):593.
[7] Bagi HM, Soleimanpour M, Abdollahi F, Soleimanpour H. Evaluation of clinical outcomes of patients with mild symptoms of coronavirus disease 2019 (COVID-19) discharged from the emergency department. PLoS One. 2021;16(10):e0258697.
[8] Tekantapeh ST, Nader ND, Ghojazadeh M, Fereidouni F, Soleimanpour H. Prone positioning effect on tracheal intubation rate, mortality and oxygenation parameters in awake non-intubated severe COVID-19-induced respiratory failure: a review of reviews. Eur J Med Res. 2024;29(1):63.
[9] Tahsini Tekantapeh S, Ghojazadeh M, Ghamari AA, Mohammadi A, Soleimanpour H. Therapeutic and anti-inflammatory effects of baricitinib on mortality, ICU transfer, clinical improvement, and CRS-related laboratory parameters of hospitalized patients with moderate to severe COVID-19 pneumonia: a systematic review and meta-analysis. Expert Rev Respir Med. 2022;16(10):1109-32.
[10] Mousavi S, Bereswill S, Heimesaat MM. Immunomodulatory and antimicrobial effects of vitamin C. European Journal of Microbiology and Immunology EuJMI. 2019;9(3):73-9.
[11] Cai Y, Li Y-F, Tang L-P, Tsoi B, Chen M, Chen H, et al. A New Mechanism of Vitamin C Effects on A/FM/1/47(H1N1) Virus-Induced Pneumonia in Restraint-Stressed Mice. BioMed Research International. 2015;2015(1):675149.
[12] Mahmoodpoor A, Shadvar K, Sanaie S, Hadipoor MR, Pourmoghaddam MA, Saghaleini SH. Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit: a preliminary study. BMC Infectious Diseases. 2021;21(1):616.
[13] Fowler AA, Syed AA, Knowlson S, Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. Journal of translational medicine. 2014;12:1-10.
[14] Lee SI, Lim CM, Koh Y, Huh JW, Lee JS, Hong SB. The effectiveness of vitamin C for patients with severe viral pneumonia in respiratory failure. J Thorac Dis. 2021;13(2):632-41.
[15] Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017;151(6):1229-38.
[16] Ao G, Li J, Yuan Y, Wang Y, Nasr B, Bao M, et al. Intravenous vitamin C use and risk of severity and mortality in COVID-19: A systematic review and meta-analysis. Nutr Clin Pract. 2022;37(2):274-81.
[17] Gavrielatou E, Xourgia E, Xixi NA, Mantelou AG, Ischaki E, Kanavou A, et al. Effect of Vitamin C on Clinical Outcomes of Critically Ill Patients With COVID-19: An Observational Study and Subsequent Meta-Analysis. Frontiers in Medicine. 2022;9.
[18] Kow CS, Hasan SS, Ramachandram DS. The effect of vitamin C on the risk of mortality in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials. Inflammopharmacology. 2023;31(6):3357-62.
[19] Kwak SG, Choo YJ, Chang MC. The effectiveness of high-dose intravenous vitamin C for patients with coronavirus disease 2019: A systematic review and meta-analysis. Complement Ther Med. 2022;64:102797.
[20] Olczak-Pruc M, Świeczkowski D, Ladny J, Pruc M, Juárez-Vela R, Rafique Z, et al. Vitamin C Supplementation for the Treatment of COVID-19: A Systematic Review and Meta-Analysis. Nutrients. 2022;2022:4217.
[21] Rawat D, Roy A, Maitra S, Gulati A, Khanna P, Baidya DK. Vitamin C and COVID-19 treatment: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndr. 2021;15(6):102324.
[22] Vollbracht C, Kraft K. Feasibility of Vitamin C in the Treatment of Post Viral Fatigue with Focus on Long COVID, Based on a Systematic Review of IV Vitamin C on Fatigue. Nutrients. 2021;13(4).
[23] Xu C, Yi T, Tan S, Xu H, Hu Y, Ma J, et al. Association of Oral or Intravenous Vitamin C Supplementation with Mortality: A Systematic Review and Meta-Analysis. Nutrients. 2023;15(8).
[24] Lykkesfeldt J, Tveden-Nyborg P. The Pharmacokinetics of Vitamin C. Nutrients. 2019;11(10).
[25] Upadhya S, Rehman J, Malik AB, Chen S. Mechanisms of Lung Injury Induced by SARS-CoV-2 Infection. Physiology (Bethesda). 2022;37(2):88-100.
[26] Alimohamadi Y, Yekta EM, Sepandi M, Sharafoddin M, Arshadi M, Hesari E. Hospital length of stay for COVID-19 patients: a systematic review and meta-analysis. Multidiscip Respir Med. 2022;17(1):856.
[27] Wunsch H. Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology. Am J Respir Crit Care Med. 2020;202(1):1-4.
[28] Balafar M, Mahmoodpoor A, Arjmandi H, Khelejani AM, Soleimanpour H. High-Dose Vitamin C in the Treatment of Covid-19 Patients in Intensive Care Unit; A Letter to the Editor. Archives of Academic Emergency Medicine. 2024;12(1):e41.
[29] Sinnberg T, Lichtensteiger C, Hill-Mündel K, Leischner C, Niessner H, Busch C, et al. Vitamin C Deficiency in Blood Samples of COVID-19 Patients. Antioxidants (Basel). 2022;11(8).
[30] Chiscano-Camón L, Ruiz-Rodriguez JC, Plata-Menchaca EP, Martin L, Bajaña I, Martin-Rodríguez C, et al. Vitamin C deficiency in critically ill COVID-19 patients admitted to intensive care unit. Frontiers in Medicine. 2023;10.
[31] Fisher BJ, Kraskauskas D, Martin EJ, Farkas D, Wegelin JA, Brophy D, et al. Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid. Am J Physiol Lung Cell Mol Physiol. 2012;303(1):L20-32.
[32] Soleimanpour H. The magical role of vitamin C on adrenal insufficiency subsequent to etomidate administration: ongoing challenges in the management of trauma patients. Int J Drug Res Clin. 2023;1:e1.
[33] Panahi JR, Paknezhad SP, Vahedi A, Shahsavarinia K, Laleh MR, Soleimanpour H. Effect of vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients: a randomized clinical trial. BMC Anesthesiol. 2023;23(1):104.
[34] Shahsavarinia K, Ghojazadeh M, Ghabousian A, Hatefnia F, Soleimanpour M, Soleimanpour H. An Umbrella Review of Clinical Efficacy and Adverse Cardiac Events Associated with Hydroxychloroquine or Chloroquine with or Without Azithromycin in Patients with COVID-19. Anesth Pain Med. 2021;11(4):e115827.
| Files | ||
| Issue | Article in Press |
|
| Section | Review Article(s) | |
| Keywords | ||
| COVID-19 Vitamin C Mortality Hospital length of stay Review | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Shahsavarinia K, Musazadeh S, Ghojazadeh M, Milanchian N, Soleimanpour M, Soleimanpour H. Role of Vitamin C for the Treatment of COVID-19: An Umbrella Review. Arch Anesth & Crit Care. 2025;.
