arinazari

https://app.suno.ai/song/bb87faff-4dd2-4906-8970-a695cbeb49d...

i would love if years later it turned out he didn't just have "nobelitis" and was right in some respects. but this is one small pilot study and the larger body of literature around it shows mixed results. not saying it should be disregarded, but there are several reasons why it's not exciting and it shouldn't be mistaken for a anything more than a pilot trial to evaluate safety.

i'm sure there's a lot more to criticize than i can see, but:

1) study's primary outcome of increased urine output is not necessarily clinically meaningful---urine output (UOP) is selected because in septic shock (sepsis + low blood pressure), organs slowly shut down with the kidneys typically being the first to go. thus, UOP can be informative as a measure of renal perfusion and ultimately end-organ damage. however, the control arm received D5 fluids [water? saline?] alone, whereas intervention group received D5 fluids + NaAscorbate, thus ultimately receiving more solute. you would expect when given a more osmolar solution, you would see increased diuresis (solute will draw in water in the kidney's tubules, thus more urine output). additionally, vitamin c itself is renally excreted, thus if the kidneys are working to excrete high doses of NaAscorbate, the tubular cells could alter their usual reabsorption and secretion patterns, potentially affecting overall fluid balance.

2) as above this is a small pilot study; however, the authors (laudably) include their power calculations in which they used an effect size of 900cc UOP. the difference in mean UOP between the groups was 891cc's, so it's dubiously powered (even if we ignore consideration (1)). accordingly, their 95% confidence interval itself crosses 0 meaning no difference in effect was detected in urine output (thus their p values was >0.05). you have to wonder what statistical games might have been played to p-hack when results come so close.

ultimately why this isn't news is that the 'next phase of human trials' have already been conducted on vitamin c in sepsis.

there's a few other things: mean baseline CRP was notably much higher in the intervention group, and it makes me wonder if this affects the effect size considering that anyone in sepsis might benefit from fluids (though they received so little overall).