Vitamin C Supplementation During Intensive Care Unit Stay Is Associated With Improved Outcomes in Critically Ill Patients With Sepsis‐Induced Coagulopathy: A Cohort Study

ABSTRACT This study aimed to investigate whether vitamin C provides survival benefit in critically ill patients with sepsis‐induced coagulopathy (SIC). Patients with SIC admitted to the ICU were identified from the Medical Information Mart for Intensive Care (MIMIC)‐IV database. The exposure factor was vitamin C supplementation during the ICU stay. The primary outcome was 28‐day all‐cause mortality, the secondary outcome was 60‐day all‐cause mortality, in‐ICU mortality, and the extended outcomes included duration of mechanical ventilation, ICU stay, and hospital stay. Both propensity score matching (PSM) and multivariable Cox models were employed to adjust for potential confounders. Sensitivity analyses and subgroup assessments were also performed to verify the study findings. A total of 18,283 eligible patients were enrolled in the entire unmatched cohort, and 2251 patients were included in the matched cohort. In PSM analysis, vitamin C supplementation was associated with decreased 28‐day all‐cause mortality (HR, 0.52; 95% CI, 0.40–0.69; p < 0.001), 60‐day all‐cause mortality (HR, 0.69; 95% CI, 0.54–0.86; p < 0.001), and ICU mortality (OR, 0.70; 95% CI, 0.50–0.97; p < 0.001). However, the duration of mechanical ventilation was significantly longer in the vitamin C group (median 42 vs. 53 h, p < 0.001). During ICU admission, continuous vitamin C supplementation for over 6 days was associated with improved 28‐day in‐hospital outcomes in patients with SIC. Sensitivity analysis using the unmatched cohort confirmed these findings (HR, 0.58; 95% CI, 0.45–0.75; p < 0.001). Vitamin C supplementation may reduce mortality in critically ill patients with SIC. However, further high‐quality prospective studies are still needed to validate these findings.