Vitamin C – neue Therapiemöglichkeit bei Sepsis?

Zusammenfassung

Die Sepsis ist eine häufige und schwere Erkrankung mit vielfältigen pathophysiologischen Veränderungen. Wiederholt wurde versucht, mit neuen Therapieansätzen den Verlauf der Sepsis positiv zu beeinflussen. Als neue Therapieoption rückte in den letzten Jahren Vitamin C in den Fokus der Sepsisforschung. Ob Vitamin C diese Hoffnungen erfüllen kann, soll in diesem Beitrag erläutert werden.

Abstract

Vitamin C deficiency often occurs in critical illness and especially in patients with sepsis. Low plasma levels correlate with organ dysfunction and outcome parameters. Vitamin C offers pleiotropic effects possibly attenuating pathophysiology in sepsis. This includes antioxidative effects like scavenging reactive oxygen species or restoring other antioxidants. Vitamin C is a cofactor for norepinephrine biosynthesis and it protects endothelial function. In addition, it modulates immune response. A combined therapy with vitamin C, hydrocortisone and thiamine could be beneficial because of synergistic effects. Some clinical studies have shown reduced mortality due to vitamin C alone or in combination with hydrocortisone and thiamine, others do not. Adverse events are rare. So data supporting a therapy with vitamin C is still unclear. Further randomised controlled trials are necessary.

Kernaussagen

• Ein Vitamin-C-Mangel bei Sepsis ist häufig.

• Vitamin C verfügt über ein breites Wirkspektrum, das die Pathophysiologie der Sepsis positiv beeinflussen kann.

• Vitamin C ist ein erprobtes und nebenwirkungsarmes Medikament.

• Eine Kombinationstherapie mit Vitamin C, Hydrokortison und Thiamin erscheint aufgrund synergistischer Effekte sinnvoll.

• In welcher Dosierung Vitamin C verabreicht werden sollte, ist unklar und muss in weiteren Studien untersucht werden.

• Die Studienlage ist insgesamt unklar. Eine evidenzbasierte Empfehlung zur prinzipiellen Therapie mit Vitamin C allein oder im Rahmen einer Kombinationstherapie mit Hydrokortison und Thiamin kann nicht gegeben werden.

• Wenn Vitamin C eingesetzt werden sollte, stellt dies stets eine adjuvante Therapie dar. Die leitliniengerechte Sepsistherapie steht im Vordergrund.

Schlüsselwörter

Vitamin C - Ascorbinsäure - Sepsis - septischer Schock - Hydrokortison - Thiamin

Key words

vitamine C - ascorbic acid - sepsis - septic shock - hydrocortisone - thiamine

Publication History

Article published online:
26 May 2021

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