학술논문
IV Vitamin C in Adults With Sepsis: A Bayesian Reanalysis of a Randomized Controlled Trial*
Document Type
Academic Journal
Author
Angriman, Federico; Muttalib, Fiona; Lamontagne, François; Adhikari, Neill K. J.; Chassé, Michaël; Aslanian, Pierre; Bélisle, Sylvain; Cailhier, Jean-François; Carrier, François Martin; Charbonney, Emmanuel; Denault, André; Girard, Martin; Guimond, Jean-Gilles; Halwagi, Antoine; Hébert, Paul; Kolan, Christophe; Ouellet, Caroline; Robillard, Nicholas; Benettaib, Fatna; Boumahni, Dounia; Lebrasseur, Martine; Salamé, Maya; Cantin, Marie-Ève; Archambault, Patrick; Drouin, Christine; Dubé, Jean-Nicolas; Bériault, Marie-Josée; Chacon, Marco; Claveau, David; Naud, Jean-François; Rodrigue, Élise; Ting Wang, Han; Brosseau, Marc; Laufer, Brian; Marquis, François; Toupin, Francis; Lamontagne, François; D’Aragon, Frédérick; Bérard, Dominique; Grondin-Beaudoin, Brian; Leclair, Marc-André; Lesur, Olivier; Mayette, Michaël; Poulin, Yannick; Quiroz Martinez, Hector; St-Arnaud, Charles; Charbonney, Emmanuel; Albert, Martin; Bernard, Francis; Cavayas, Alexandros; Serri, Karim; Williamson, David; Duquet-Deblois, Estel; Noël-Hunter, Monia; Tapss, Danielle; Toupin, Guylaine; Tassy, Danaë; Cheung, Vincent; Toun, Sam-Ang; Carbonneau, Elaine; Bélisle, Julie; Bouchard, Marie-Pier; Côté, Line; Ladouceur, Marylène; Marchand, Joannie; Naisby, Alexandra; Robert-Petit, Louise; Thibault, Marie-Ève; Williams, Virginie; Lainer Palacios, Julia; Charbonney, Emmanuel; Albert, Martin; Bernard, Francis; Cavayas, Alexandros; Serri, Karim; Williamson, David; Lauzier, François; Francoeur, Charles; Leblanc, Guillaume; St-Onge, Maude; Turgeon, Alexis; Belley-Côté, Emilie; Fox-Robichaud, Alison; Meade, Maureen; Whitlock, Richard; Lellouche, François; Simon, Mathieu; Tung Sia, Ying; Rochwerg, Bram; Maslove, David; Gordon Boyd, J.; Drover, John; Muscedere, John; Sibley, Stephanie; Mele, Tina; Shahin, Jason; Khwaja, Kosar; Mehta, Sangeeta; Detsky, Michael; Kohli, Sonny; Cui, Fulan; Khera, Vikas; McConachie, David; Rehsia, Sachdeep; James Kutsogiannis, Demetrios; Chowdhury, Raiyan; Davidow, Jon; Johnston, Curtis; Kim, Michael; Macala, Kimberley; Marcushamer, Sam; Markland, Darren; Matheson, Doug; Parker, Arabesque; Paton-Gay, Damian; Cook, Deborah; Al-Hazzani, Waleed; Duan, Erick; Ligori, Tania; Soth, Mark; Adhikari, Neill KJ; Amaral, Andre; Cuthbertson, Brian H; Fowler, Robert A; Piquette, Dominique; Scales, Damon C; Tillmann, Bourke; Wunsch, Hannah; Seely, Andrew; English, Shane; Meggison, Hilary; Microys, Sherissa; Millington, Scott; Sarti, Aimee; Del Sorbo, Lorenzo; Fan, Eddy; Granton, John; Rewa, Oleksa; Bagshaw, Sean; Meier, Michael; Sligl, Wendy; Wood, Gordon; Ovakim, Daniel; Leblanc, Rémi; Poirier, Matthieu; Theriault, Theophile; Williston, Maryse; Bellemare, David; Boulanger, Marie-Claude; Cloutier, Eve; Guilbault, Gabrielle; Thibeault, Frédérique; Hand, Lori; Hayward, Leah; Mullen, Courtney; Savija, Nevena; Lizotte, Patricia; Millen, Tina; Boyd, Tracy; Hunt, Miranda; Bentall, Tracey; ElKhatib, Chadia; Campisi, Josie; Alam, Norine; Rahgoshai, Raham; Shah, Sumesh; Bharti, Dalisha; Perez, Adic; Hewer, Tayne; Thompson, Patrica; Clarke, France; Copland, Mary; Matic, Karlo; Marinoff, Nicole; Kamra, Maneesha; Kaur, Navjot; Murali, Deeptha; Sabananthan, Thivya; Sugumaran, Thuva; Haines, Jessica; Miezitis, Sydney; Porteous, Rebecca; Watpool, Irene; Abdelhady, Hesham; Romagnuolo, Tina; Baig, Nadia; Auld, Fiona; Carney, Gayle; Parfett, Deborah; Caissie Collette, Jackie; Carriere, Melanie; Daigle, Melissa; Gaudet, Bernise; Morin, Karine; Ouellette-Bernier, Lola; Poitras, Julie; Robichaud, Melanie; Rockburn, Joanne; Mekontso Dessap, Armand; Arrestier, Romain; Bagate, François; Bendib, Ines; Benelli, Brice; Berti, Enora; Bertier, Astrid; Cavaleiro, Pedro; de Prost, Nicolas; Gendreau, Segolene; Hartman, Otto; Haudebourg, Anne-Fleur; Lopinto, Julien; Masi, Paul; Michaud, Gaël; Razazi, Keyvan; Tuffet, Samuel; Annane, Djillali; Abdeladim, Lilia; Bounab, Rania; Heming, Nicholas; Maxime, Virginie; Moine, Pierre; Alves, Aline; Nait Chabane, Luiza; Ouali, Fariza; Ouedraogo, Rachida; Bossard, Isabelle; Jourdier, Segolene; Mahiou, Siline; Tessa, Hayette; McGuinness, Shay; Ball, Jonathan; Hennessy, Immanuel; Hogan, Maurice; Van Der Poll, Andrew; Benson-Cooper, Kerry; Chen, Jonathan; Freeman, Kirk; Harley, David; Harvey, Dave; Hourigan, Craig; Julian, Kylie; Lo, Stephen; McArthur, Colin; Miller, Stuart; Pointer, Chris; Anthony Smith, Rex; Tincknell, Laura; Shaw, Geoffrey; Betteridge, Toby; Burke, Brandon; Closey, David; Crombie, Rosalind; Davidson, Neil; Henderson, Louise; Henderson, Seton; Hitchings, Louise; Knight, David; Quigley, Christine; Ritzema Carter, Jay; Roberts, Jessica; Townend, Katherine; Twardowski, Pawel; Dvoracek, Martin; Renner, Markus; Silverman, David; Smith, Myles; Monica Stephens, Katherine; Albert Waibel, Hansjörg; Wiebe, Stefan; Woolley, Mark; Buehner, Ulrike; Kramer, Katallah; Browne, Troy; Callender, Owen; Chen, Jonathan; Farrell, Susanne; Higson, Vicky; Jackson, David; Keet, Owen; Martynoga, Robert; Byrne, Kelly; Young, Paul; Barnes, Colin; Barry, Ben; Grayson, Kim; Moore, James; Psirides, Alex; Sturland, Shawn; Tietjens, Kate; Ure, Bob; Walker, Laurence; Wright, Jason; Butler, Magdalena; Cowdrey, Keri-Anne; Gilder, Eileen; Parke, Rachael; Ryan, Samantha; Woollett, Melissa; McConnochie, Rachael; Simmonds, Catherine; Doyle, Tara; Mehrtens, Jan; Morgan, Stacey; Morris, Anna; Van Der Heyden, Kymbalee; Eden, Amie; France, Dawn; Williams, Erin; Goodson, Jennifer; Butler, Amelia; Trask, Kara; Mans, Gay; Termaat, Jonathan; Aguilar-Dano, April; Delaney, Kirsha; Lawrence, Cassie; Lesona, Mildred; Millington, Alexandra; Navarra, Leanlove; Olatunji, Shaanti; Cruz, Raulle Sol; Cruz, Rhoze Sol; Young, Chelsea; Day, Andrew; Cook, Deborah J; Guyatt, Gordon H; Sprague, Sheila; Cohen, Dian; Heyland, Daren K; Lamontagne, François; Masse, Marie-Hélène; Ménard, Julie; Adhikari, Neill KJ; Pinto, Ruxandra; Kanji, Salmaan; Battista, Marie-Claude; Annane, Djillali; Vijayaraghavan, Bharath Kumar Tirupakuzhi; McGuinness, Shay; Parke, Rachael; Arabi, Yaseen
Source
Critical Care Medicine. Aug 01, 2023 51(8):e152-e156
Subject
Language
English
ISSN
0090-3493
Abstract
OBJECTIVES:: The Lessening Organ Dysfunction with Vitamin C trial showed a harmful effect of vitamin C on 28-day death or persistent organ dysfunction. To maximize interpretation, we present a post hoc Bayesian reanalysis. DESIGN:: Bayesian reanalysis of a randomized placebo-controlled trial. SETTING:: Thirty-five ICUs. PATIENTS:: Adults with proven or suspected infection, vasopressor support, and no more than 24 hours of ICU admission. INTERVENTIONS:: Patients were allocated to receive either vitamin C (50 mg/kg of body weight) or placebo every 6 hours for up to 96 hours. MEASUREMENTS AND MAIN RESULTS:: The primary outcome was the composite of death or persistent organ dysfunction (i.e., vasopressor use, invasive mechanical ventilation, or new renal replacement therapy) at 28 days. We used Bayesian log-binomial models with random effects for hospital site and varying informative prior beliefs for the effect of vitamin C to estimate risk ratios (RRs) with 95% credible intervals (Crls) in the intention to treat population (vitamin C, 435 patients; placebo, 437 patients). Using weakly neutral priors, patients allocated to vitamin C had a higher risk of death or persistent organ dysfunction at 28 days (RR, 1.20; 95% Crl, 1.04–1.39; probability of harm, 99%). This effect was consistent when using optimistic (RR, 1.14; 95% Crl, 1.00–1.31; probability of harm, 98%) and empiric (RR, 1.09; 95% Crl, 0.97–1.22; probability of harm, 92%) priors. Patients allocated to vitamin C also had a higher risk of death at 28 days under weakly neutral (RR, 1.17; 95% Crl, 0.98–1.40; probability of harm, 96%), optimistic (RR, 1.10; 95% Crl, 0.94–1.30; probability of harm, 88%), and empiric (RR, 1.05; 95% Crl, 0.92–1.19; probability of harm, 76%) priors. CONCLUSIONS:: The use of vitamin C in adult patients with proven or suspected infection and vasopressor support is associated with high probability of harm.