Baseline Serum Vitamin C Levels in Pediatric Sepsis: Hazard of Mortality and Organ Dysfunction in a Single-Center Prospective Cohort.

OBJECTIVES

To explore whether baseline serum vitamin C levels are associated with 28-day mortality and organ dysfunction in pediatric sepsis.

DESIGN

Single-center, prospective cohort, 2021 to 2023.

SETTING

Tertiary children's hospital PICU in China.

PATIENTS: Patients 18 years old or younger with suspected infection and organ dysfunction.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Serum vitamin C concentrations were measured in 141 patients within 24 hours of PICU admission. The median (interquartile range) vitamin C level was 4.3 μg/mL (2.5-7.2). Patients were categorized into quartiles (Q) and the primary endpoint was 28-day mortality; the secondary endpoint was the pediatric Sequential Organ Failure Assessment (pSOFA) score on day 1. Overall, a quarter of our cohort were deficient in vitamin C (< 2.5 μg/mL). In multivariable Cox and linear regression analyses, each 1 sd (3.04 μg/mL) increase in vitamin C was associated with a 52% reduction in 28-day mortality (adjusted hazard ratio [HR] 0.48; 95% CI, 0.30-0.76) and a 0.67-point decrease in pSOFA (β -0.67; 95% CI, -1.1 to -0.22). Compared with Q1, Q3 had the lowest adjusted hazard of mortality (HR 0.19; 95% CI, 0.05-0.70) and the least severe organ dysfunction (β -1.5; p = 0.018). Restricted cubic spline analysis suggested a linear inverse relationship between vitamin C and mortality, but a nonlinear inverse association with pSOFA. Subgroup analyses demonstrated more pronounced associations in patients not receiving corticosteroids and in those with normal renal function.

CONCLUSIONS

In children with suspected infection and organ dysfunction, subsequent 28-day mortality and organ dysfunction are associated with serum vitamin C level in the first 24 hours of PICU admission.