This study is a prospective, randomized, double-blinded, parallel-controlled, multi-central clinical trial for patients with severe acute pancreatitis (SAP). Patients with SAP in the early stage (within 7 days of onset) and over the age of 18, based on the routine treatment, will be randomly divided into a high-dose intravenous vitamin C group (HDIVC, 500mg/kg/24h, administered by iv. pump at a rate of 2g/h for 7 days) and a control group (an equal volume of normal saline). The primary endpoint is mortality rate in ICU, and secondary endpoints include free organ support duration (FOSD) within 14 days after enrollment, changes in inflammatory response and severity, disease severity scores and changes, fluid retention, incidence of infectious pancreatic necrosis (IPN), ICU mortality, pancreatic necrosis scores, monitoring of vitamin C plasma concentrations before and after HDIVC use, composition of gut microbiota, observation of vitamin C-related adverse reactions. The study hypothesis is that HDIVC can reduce mortality rate in ICU, significantly decrease the FOSD within 14 days and significantly reduce inflammatory response, decrease fluid retention, and improve disease severity.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
388
The control group involves only adding 50ml of normal saline to a 50ml syringe, without any labels to ensure identical appearance, and the method of administration and dosage are the same with vitamin C group.
Vitamin C at dose of 500mg/kg/24h, 2g/h
Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital
Shanghai, Shanghai Municipality, China
Mortality rate in ICU
Time frame: through study completion, an average of 6 months
The Impact of HDIVC on Free Organ Support Duration (FOSD) within 14 Days of Enrollment
Time frame: 14 days of enrollment
The Impact of HDIVC on Early Inflammatory Markers in SAP, Including the Levels and Changes of C-Reactive Protein and Inflammatory Cytokines IL-6, IL-1, and IL-10
Time frame: 28 days of enrollment
the Duration of Systemic Inflammatory Response Syndrome (SIRS)
The scoring system primarily includes the following four clinical indicators. If ≥2 criteria are met, SIRS can be diagnosed: 1. Temperature \>38°C or \<36°C 2. Heart Rate\>90 beats per minute 3. Respiratory rate \>20 breaths per minute, or arterial PaCO₂ \<32 mmHg 4. Abnormal White Blood Cell (WBC) Count \>12×10⁹/L or \<4×10⁹/L, or immature neutrophils \>10%
Time frame: 28 days of enrollment
The Impact of HDIVC on Sequential Organ Failure Assessment (SOFA) Score
The SOFA score involves six major organ systems, including the respiratory system, hematologic system (platelets), liver function, renal function, central nervous system, and circulatory system (blood pressure). Each system is scored from 0 to 4, with a total score ranging from 0 to 24. Higher scores indicate that the organ failure is more severe.
Time frame: 28 days of enrollment
The Impact of HDIVC on Modified Marshall Score
This scoring system primarily evaluates three key organ systems (respiratory system, circulatory system and renal function), with each system scored from 0 to 4. If any system scores ≥2, organ dysfunction is considered present.
Time frame: 28 days of enrollment
The Impact of HDIVC on Fluid Retention
assessment of fluid retention, defined as the total input volume of intravenous fluid and enteral nutrition minus the output volume of urine and drainage
Time frame: 28 days of enrollment
The Impact of HDIVC on Acute Physiology and Chronic Health Evaluation II (APACHE II) Score
It is a severity-of-disease classification system used to assess critically ill patients and predict hospital mortality. The score is calculated based on three main components: Acute Physiology Score (APS) (0-60 points), Age Score (0-6 points) and Chronic Health Condition Score (0-5 points). It has a maximum total score of 71 points. The higher the APACHE II score, the greater the risk of mortality.
Time frame: 28 days of enrollment
The Impact of HDIVC on Bedside Index for Severity in Acute Pancreatitis (BISAP) Score
It is a scoring system used for early assessment of disease severity and prognosis in patients with acute pancreatitis (AP). Each item scores 1 point, total 0-5 points. B - BUN \> 25 mg/dL (Blood Urea Nitrogen \> 25 mg/dL) I - Impaired mental status (Glasgow Coma Scale \[GCS\] \< 15) S - SIRS (Systemic Inflammatory Response Syndrome) (Meeting ≥2 criteria) A - Age \> 60 years P - Pleural effusion BISAP helps predict mortality risk and complications.0-1 points means very low mortality risk (\<1%). 2-3 points means moderate risk (mortality rate \~2-10%). 4-5 points means high risk (mortality rate \>20%).
Time frame: 28 days of enrollment
The Impact of HDIVC on Pancreatic Necrosis, namely Computed Tomography Severity Index (CTSI).
It is a scoring system used to assess the severity of acute pancreatitis (AP) based on contrast-enhanced CT (CECT) imaging. CTSI helps predict disease severity, complications, and prognosis. It categorizes acute pancreatitis severity as follows: 0-3 points: Mild pancreatitis, low risk of complications 4-6 points: Moderate pancreatitis, higher risk of complications and organ failure 7-10 points: Severe pancreatitis, high risk of necrosis, organ failure, and mortality
Time frame: 28 days of enrollment
The Incidence of IPN (Infection-Related Pancreatic Necrosis)
Time frame: 28 days of enrollment
ICU Stay Duration
Time frame: through study completion, an average of 6 months
Hospitalization Costs
Time frame: through study completion, an average of 6 months
Plasma Concentration of Vitamin C Before and After Treatment
Time frame: 28 days of enrollment
Adverse events related to Vitamin C
Time frame: 28 days of enrollment
The Impact of HDIVC on the Composition of the Gut Microbiota
The study use the fecal sample to assess the composition of gut microbiota using sequencing techniques (16S rRNA, metagenomics), diversity analysis (alpha and beta diversity), functional profiling (metabolomics) and inflammation markers (calprotectin).
Time frame: 28 days of enrollment
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