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Role of AScorbic acid Infusion in critically ill patients with Transfusion Related Acute Lung Injury (ASTRALI)
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  • Amira kassem,
  • Islam Ahmed,
  • Gamal Omran,
  • Mohamed Megahed,
  • Tamer Habib
Amira kassem
Damanhour University Faculty of Pharmacy

Corresponding Author:amira.kassem@pharm.dmu.edu.eg

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Islam Ahmed
Damanhour University Faculty of Pharmacy
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Gamal Omran
Damanhour University Faculty of Pharmacy
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Mohamed Megahed
Alexandria University Faculty of Medicine
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Tamer Habib
Alexandria University Faculty of Medicine
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Abstract

Introduction: In critically ill patients, Transfusion Related Acute Lung Injury (TRALI) remains the leading cause of transfusion-related fatalities in critical care setting and associated with inflammation and oxidative stress state. Recent research raised the potential efficacy of high dose intravenous ascorbic acid in critically ill patients. Objective: The aim of this trial was to investigate the effect of high dose intravenous ascorbic acid (VC) as a targeted therapy for TRALI in terms of serum proinflammatory (interleukin-8, interleukin-1β, C-reactive protein), anti-inflammatory (interleukin-10), oxidative stress (superoxide dismutase, malondialdehyde) markers, and plasma VC levels. Secondary outcomes were oxygenation (PaO2/FiO2 ratio), vasopressor use, duration of mechanical ventilation, ICU length of stay, 7-days mortality and 28-days mortality. Methods: Eighty critically ill patients with TRALI (n=80) were randomized to receive 2.5gm/6hr intravenous vitamin C for 96 hours (ASTRALI group) or placebo. Patients were followed-up to measure the outcomes initially (T0) and at the end of treatment (T96). Results: When compared to control group, ASTRALI group at T96, showed significantly higher median of interleukin-10 (31.6 ± 25.8 Vs. 17.7 ± 12.0 pg/mL, p<0.0001) levels and superoxide dismutase (12876 ± 4627 U/L Vs. 5895 ± 6632 U/L, p<0.0001) activities, lower median C-reactive protein (76 ± 50 Vs. 89 ± 56 mg/L, p=0.033), interleukin-8 (11.8 ± 7.3, 35.5 ± 19.8 pg/mL, p<0.0001), and malondialdehyde (0.197 ± 0.034 Vs. 0.234 ± 0.074 µM/L, p=0.002) levels. Conclusion: High dose ascorbic acid was associated with significantly reduced oxidative stress, reduced pro-inflammatory markers except IL-1β, elevated anti-inflammatory marker, and elevated plasma VC levels
17 Oct 2021Submitted to British Journal of Clinical Pharmacology
19 Oct 2021Submission Checks Completed
19 Oct 2021Assigned to Editor
25 Oct 2021Reviewer(s) Assigned
11 Nov 2021Review(s) Completed, Editorial Evaluation Pending
11 Nov 2021Editorial Decision: Revise Minor
16 Nov 20211st Revision Received
16 Nov 2021Submission Checks Completed
16 Nov 2021Assigned to Editor
16 Nov 2021Review(s) Completed, Editorial Evaluation Pending
17 Nov 2021Editorial Decision: Accept
May 2022Published in British Journal of Clinical Pharmacology volume 88 issue 5 on pages 2327-2339. 10.1111/bcp.15167