Literaturni pregled vloge vitamina C pri covid-19

Golubić, Tara (author), Mravljak, Janez (mentor)

Ozadje: V času pandemije koronavirusne bolezni 2019 (COVID-19) so raziskovalci začeli proučevati uporabo vitamina C kot podporne terapije. Dodajanje vitamina C, ki je znan po svoji antioksidativni, protivnetni in imunomodulatorni vlogi, je že v preteklosti pokazalo pozitivne učinke pri zdravljenju raznih respiratornih okužb, kot sta sindrom akutne dihalne stiske (ARDS) in pljučnica. Osrednji razlog za težke poškodbe pljučnega tkiva, do katerih pride pri bolezni COVID-19, je oksidativni stres zaradi prekomerne tvorbe reaktivnih kisikovih in dušikovih zvrsti, ki nastanejo kot posledica prekomernega imunskega odziva. Posledično bi lahko vitamin C imel pomembno vlogo pri zaščiti zdravega tkiva, saj je sposoben nevtralizirati nastale reaktivne zvrsti. Namen dela: Analizirati želimo objavljene raziskave, ki proučujejo status vitamina C pri bolnikih s COVID-19 ali vpliv njegovega dodajanja na potek ter končni izid bolezni. Metode: Izvedli smo literaturni pregled izsledkov raziskav o statusu vitamina C ter njegovi vlogi pri COVID-19. Raziskave smo iskali v podatkovnih bazah PubMed, WHO (Global literature on coronavirus disease) in Google Scholar. Izbrali smo jih glede na vključitvene in izključitvene kriterije v skladu s smernicami PRISMA. Po izboru raziskav je sledila izvedba metaanalize ustreznih študij s programom Review Manager 5.4.1. Glavni preučevani izidi so bili smrtnost, čas trajanja hospitalizacije, čas zdravljenja na enoti intenzivne nege in potreba po umetnem predihavanju pljuč. Rezultati: V skladu s smernicami PRISMA smo izbrali 20 raziskav, ki so ustrezale našim vključitvenim kriterijem. Raziskave smo analizirali glede na državo izvedbe, leto objave, število udeležencev in vrsto raziskave. Raziskave smo obravnavali glede na predmet preučevanja ter jih razdelili v dve skupini – na raziskave, ki preučujejo status vitamina C pri bolnikih in raziskave, ki preučujejo izid bolezni po dodajanju vitamina C. V metaanalizo smo vključili 9 raziskav. Dodajanje vitamina C ni imelo statistično značilnega vpliva na zmanjšanje smrtnosti (RR = 0,74, 95 % CI 0,56 do 1,00, p = 0,05), čas trajanja hospitalizacije (RR = -0,14, 95 % CI -0,78 do 0.50, p = 0,67), čas zdravljenja na enoti intenzivne nege (RR = 0,31, 95 % CI 0,15 do 0,46, p = 0,0001) ter potrebo po umetnem predihavanju pljuč (RR = 0,93, 95 % CI 0,61 do 1,44, p = 0,76). Sklep: Rezultati raziskav poročajo, da je pri bolnikih s COVID-19 prisotno pomanjkanje vitamina C. Iz rezultatov raziskav je razvidno, da ima lahko dodajanje vitamina C omejen pozitiven vpliv na potek bolezni, predvsem na zmanjšanje vrednosti vnetnih označevalcev, vendar tega vpliva na izbrane parametre z metaanalizo nismo dokazali. Za boljše in natančnejše rezultate bi bilo treba vključiti več obsežnih, randomiziranih kliničnih raziskav.

• Language: Slovenian
• Keywords: COVID-19, SARS-CoV-2, vitamin C, metaanaliza
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2022
• PID: 20.500.12556/RUL-142509
• Publication date in RUL: 12.11.2022

Secondary language

• Language: English
• Title: Literature review of vitamin C role in COVID-19

Abstract

Background: Due to the new coronavirus (COVID-19) pandemic researchers started evaluating a possibility of using vitamin C as a support therapy. The vitamin has a known role as an antioxidant, anti-inflammatory agent and immunomodulator. Adding vitamin C has previously shown limited positive effect on patients with respiratory complications such as ARDS and pneumonia. The main reason for severe lung damage in COVID-19 is oxidative stress due to the excessive production of reactive oxygen and nitrogen species that arise as a result of an excessive immune system response. Subsequently the vitamin C could have, due to its mechanism of action, a key role in preventing oxidative damage to healthy lung cells. Aim: Our intent is to analyse published research papers in which they evaluate the status of vitamin C in the blood of COVID-19 patients and the effect of adding it as a part of therapy on the disease’s final outcomes. Methods: We conducted a literature review of studies found on PubMed, WHO database (Global literature on coronavirus disease) and Google Scholar. The studies were chosen according to the inclusion and exclusion criteria based on the PRISMA guidelines. After the filtration we conducted a metaanalysis with Review Manager 5.4.1. The outcomes we focused on were mortality, duration of hospitalization, intensive care unit length of stay and the need for mechanical ventilation. Results: Accoarding to the PRISMA guidelines we chose 20 studies that fitted our criteria. We analysed these studies based on the country and year of conduction, number of studied patients and type of a study. The studies were clustered based on similarity of an outcome in two groups – those which studied status of patients' vitamin C status and those that studied the effect of adding VC on the disease's outcome. We included 9 studies in our metaanalysis. Vitamin C treatment did not have a statistically significant effect on mortality reduction (RR = 0.74, 95 % CI 0.56 to 1.00, p = 0.05), time of duration of hospitalization (RR = -0.14, 95 % CI -0.78 to 0.50, p = 0.67), time of ICU stay (RR = 0.31, 95 % CI 0.15 to 0.46, p = 0.0001) or the need for mechanical ventilation (RR = 0.93, 95 % CI 0.61 to 1.44, p = 0.76). Conclusion: Our results conclude that VC deficiency is present in COVID-19 patients. VC treatment could possibly have limited positive effect on disease's outcome but data from our studies could not confirm that. For more accurate and conclusive results, we would need to include more RCT studies with larger number of patients.

• Keywords: COVID-19, SARS-CoV-2, vitamin C, metaanalysis