*3.2.1 Studies about ascorbic acid in septic shock and sepsis*

Vitamin C is considered particularly important as L-ascorbic acid plays a large role in the health of animal organisms. The human body, due to the absence of an enzyme, like other higher primates, lacks the ability to synthesize vitamin C. For this reason, it should receive the necessary daily amount through its diet. A lack of vitamin C is known to cause scurvy, a disease that primarily manifests itself in bleeding. Today, by changing the diet and incorporating fruits and vegetables, the disease tends to disappear. L-ascorbic acid is good for people with sepsis and septic shock, according to research.

Carr et al. [21] studied a sample of 44 critically ill patients, 24 of whom had septic shock, 17 of whom did not have sepsis, and three of whom were unclassified. It turned out that 40% of patients with septic shock were deficient in vitamin C (ascorbic acid), compared to 25% of non-septic patients, and they came to the conclusion that this is likely because of increased metabolism because of the increased inflammatory response seen in septic shock.

Twenty-four patients with severe sepsis were randomly divided into three groups in their study by Fowler et al. [22] at a ratio of 1:1:1. For 4 days, ascorbic acid was intravenously infused into the first group (Lo-AscA, n = 8; Hi-AscA, n = 8; and placebo, n = 8) once every 6 hours. Patients who received ascorbic acid experienced immediate declines in the SOFA test, whereas patients who received a placebo did not. C-reactive protein and procalcitonin (PCT), two pro-inflammatory biomarkers, were considerably decreased. In contrast to patients receiving placebo, thrombomodulin infusion in patients receiving ascorbic acid did not show a significant increase, indicating an attenuation of vascular endothelial damage.

In a study by Marik et al. [23], they divided the 94 patients into the ascorbic acid treatment group (n = 47) and the control group (n = 47). Their results showed that inhospital mortality was 8.5% (4 of 47) in the ascorbic acid treatment group, compared with 40.4% (19 of 47) in the control group.

Additionally splitting 24 patients into two groups, Natarajan et al. [24] discovered that Cf-DNA readings were greater and persisted above normal for 96 hours. While MtDNA readings fell in the treatment group, they rose in the placebo group. While

*Ascorbic Acid in Sepsis and Septic Shock DOI: http://dx.doi.org/10.5772/intechopen.109515*

the expression of antimicrobial proteins increased considerably only in the treatment groups, red cell distribution width (RDW) only significantly increased in the placebo group. Ascorbic acid infusion can improve sepsis outcomes by lowering cf. and mtDNA levels, increasing endogenous antimicrobial proteins, and maintaining Red cell distribution width (RDW), according to the researchers' findings.

Ascorbic acid, thiamine, and hydrocortisone have been demonstrated in a recent study by Sadaka et al. [25] to have benefits for patients with septic shock in 62 individuals.

In a trial on a sample of 1144 participants, Shin et al. [26] found that timely vitamin C and thiamine delivery did not increase survival in patients with septic shock, but that it might in more severe circumstances such as hypoalbuminemia or acute organ failure. Particularly, there was no difference in fatality rates between the treatment and control groups (18.3% vs. 17.5%).
