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

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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.

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