Esophagus to Small Intestine

Aliment Pharmacol Ther. 2023;57(3):313–22

Hui S, Lim A, Koh E, Abasszade J, Morgan A, Tan PY, Lemoh C, Robertson M

Prevalence and prognostic significance of vitamin C deficiency in patients with acute upper gastrointestinal bleeding: A prospective cohort study

Background: Vitamin C is an essential dietary nutrient important for collagen synthesis, including within the gastrointestinal tract.
Aim: The authors aimed to document the prevalence of vitamin C deficiency (VCD) in patients who present with upper gastrointestinal bleeding (UGIB) and its association with clinical outcomes.
Methods: They conducted a prospective cohort study of patients presenting with UGIB. Fasting vitamin C levels were collected at admission. Primary outcomes were the prevalence of VCD (vitamin C level < 23 μmol/l, severe VCD < 12 μmol/l) and a composite outcome of adverse events, stratified by VCD status. Secondary outcomes were prolonged hospitalization and the need for intensive care unit admission.
Results: A total of 227 patients were included (mean age, 64.5 years, males 63.9%). VCD was identified in 74 (32.6%) and severe deficiency in 32 (14.1%) patients. VCD was associated with a higher composite end point of adverse events (AEs) (45.9% vs. 24.8%, p < 0.01), higher in-hospital mortality (9.5% vs. 1.3%, p < 0.01), increased prolonged admissions (62.2% vs. 47.1%, p = 0.03) and increased rebleeding (17.6% vs. 7.8%, p = 0.03), compared with patients with normal vitamin C levels. Multivariate logistic regression models showed that VCD was independently associated with the composite end point of AEs.

Conclusion: Vitamin C deficiency is highly prevalent in patients with upper gastrointestinal bleeding and associated with poorer outcomes, including higher mortality, rebleeding and length of stay. Interventional studies are required to determine the impact of early vitamin C supplementation on clinical outcomes.

S. Hui, Department of Gastroenterology and Hepatology, Monash Medical Center, Melbourne, VIC, Australia,

DOI: DOI: 10.1111/apt.17359

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