Clinical Effect of Intravenous Vitamin C on Viral Myocarditis in Children: A Systematic Review and Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical trials
PubMed 31178914 · doi:10.1155/2019/3082437
What was done
Authors conducted a systematic review and meta-analysis searching PubMed, Cochrane Library, CNKI, China Science and Technology Journal Database, and Wanfang database for clinical trials published between January 2000 and February 2018. They compared conventional therapy combined with intravenous vitamin C against conventional therapy alone in children with viral myocarditis. Study quality was evaluated using the Cochrane risk-of-bias method (version 5.1.0) by two independent researchers, and pooled data were analyzed with RevMan 5.3.
What was found
Eight studies with 789 total patients (426 intervention, 363 control) were included: - Total effective rate (6 studies): Higher in the IV vitamin C group [effect estimate 1.21, 95% CI: 1.13 to 1.30, P < 0.00001; Z = 5.46]. - LDH levels (5 studies): Lower in the IV vitamin C group [effect size -1.88, 95% CI: -2.88 to -0.88, P = 0.0002; Z = 3.70]. - CK levels (3 studies): Lower in the IV vitamin C group [effect size -0.55, 95% CI: -0.81 to -0.30, P < 0.0001; Z = 4.21]. - CK-MB levels (4 studies): Lower in the IV vitamin C group [effect size -1.44, 95% CI: -1.65 to -1.24, P < 0.00001; Z = 13.64]. - CD3 levels (2 studies): Higher in the IV vitamin C group [effect size 0.41, 95% CI: 0.08 to 0.73, P = 0.01; Z = 2.45]. - CD4 levels (2 studies): No significant difference [effect size -0.21, 95% CI: -1.69 to 1.28, P = 0.78; Z = 0.28]. - CD4/CD8 ratio (2 studies): No significant difference [effect size -0.03, 95% CI: -0.73 to 0.67, P = 0.94; Z = 0.07].
Why it matters
This review suggests that adjunct intravenous vitamin C may lower biochemical markers of myocardial injury and increase overall response rates in pediatric viral myocarditis.
Limits
The total sample size is small (8 studies, 789 patients), and key sub-analyses rely on only 2 to 5 small trials. The abstract does not specify vitamin C dosing, treatment duration, trial randomization or blinding adequacy, or long-term clinical endpoints such as heart failure, arrhythmias, or mortality.
Cited by
- partial A meta-analysis found that intravenous vitamin C combined with conventional therapy is more effective than conventional therapy alone for treating viral myocarditis in children.