Skip to main content

Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome

Vitamin C is an antioxidant with anti-inflammatory and immune-supportive properties. Its levels are decreased in patients with sepsis-related acute respiratory distress syndrome (ARDS). Moreover, a significant number of patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease developed ARDS [1]. Therefore, we hypothesized that ARDS coronavirus disease 2019 (COVID-19) patients may present vitamin C deficiency.

Plasma vitamin C levels in a population of adult ICU patients COVID-19 who met ARDS criteria according to the Berlin definition [2] were prospectively measured. The study was approved by the local Clinical Research Ethics Committee (PR (AG)270/2020). Main characteristics of the population included are presented in Table 1. None of the patients included presented shock or sepsis on admission. Equally, no bacterial co-infection during their ICU course was documented. All patients survived. Vitamin C was determined by high-performance liquid chromatography with photodiode detector (detection limit 1.5 mg/L). Vitamin C reference values in general population used to be above 5 mg/L. Seventeen patients (94.4%) had undetectable vitamin C levels and 1 patient had low levels (2.4 mg/L).

Table 1 Clinical characteristics of the COVID-19 patients included. We have included the worst PF and highest PEEP. Results of continuous variables are expressed as mean and standard deviation or median and interquartile range as appropriate. Categorical variables are expressed as frequency (percentage). SOFA sequential organ failure assessment, APACHE II Acute Physiology and Chronic Health disease Classification System II, ICU intensive care unit, PF PaO2/FiO2 ratio, PEEP positive end-expiratory pressure, AKI acute kidney injury, CRRT continuous renal replacement therapy, LMWH low-molecular-weight heparin

To our knowledge, this is the first study to analyze the levels of vitamin C in patients with SARS-CoV-2-associated ARDS. Our study revealed that vitamin C levels are undetectable in more than 90% of the patients included. The mechanisms of this significant reduction in vitamin C are uncertain. We hypothesized that several mechanisms, such as increased metabolic consumption due to the enhanced inflammatory response, glomerular hyperfiltration, dialysis, decreased gastrointestinal absorption, or decreased recycling of dehydroascorbate to ascorbic acid, may be involved.

Moreover, vitamin C may have implications for treatment of COVID-19-associated ARDS [3]. Indeed, one preclinical study showed that vitamin C increased resistance to infection caused by coronavirus [4]. Moreover, other clinical studies that included surgical patients and patients with pneumonia showed encouraging results in terms of decreased incidence and severity of lung injury and mortality [5].

Our study has several limitations mainly related with the fact that it is a unicentric study with small sample size and blood sample was obtained in different days of their course in the ICU.

In conclusion, in our cohort of patients with COVID-19-associated ARDS, the levels of vitamin C are extremely low. Despite the limited generalization of these results, we think these findings might stimulate clinicians to measure vitamin C levels in COVID-19 patients to describe the real impact of this alteration.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. 1.

    Murthy S, Gomersall C, Fowler R. Care for critically ill patients with COVID-19. JAMA. 2020.

  2. 2.

    ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutksy AS. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33.

    Google Scholar 

  3. 3.

    Carr A. A new clinical trial to test high-dose vitamin C in patients with COVID-19. Crit Care. 2020;24:133.

    Article  Google Scholar 

  4. 4.

    Atherton JG, Kratzing CC, Fisher A. The effect of ascorbic acid on infection of chick-embryo ciliated tracheal organ cultures by coronavirus. Arch Viro. 1978;56:195–9.

    Article  CAS  Google Scholar 

  5. 5.

    Nathens AB, Neff MJ, Jurkovich GJ, Klotz P, Farver K, Ruzinski JT, et al. Randomized, prospective trial of antioxidant supplementation in critically III surgical patients. Ann Surg. 2002;236:814–22.

    Article  Google Scholar 

Download references


No contributions from individuals or organizations.

Disclosure statement

The authors have no conflicts of interest to declare.


No funding.

Author information




We were all involved in providing care for the patient. We were all involved in writing and reviewing the manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Juan Carlos Ruiz-Rodriguez.

Ethics declarations

Ethics approval and consent to participate

We complied with the guidelines for human studies and our research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. Information revealing the subject’s identity is to be avoided. The study was approved by the local Clinical Research Ethics Committee (PR (AG)270/2020) with exemption from informed consent.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chiscano-Camón, L., Ruiz-Rodriguez, J., Ruiz-Sanmartin, A. et al. Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome. Crit Care 24, 522 (2020).

Download citation