Background: Ascorbic acid (AA) deficiency affects disproportionally the older population. The recognition of AA deficiency is elusive since we do not measure AA routinely. We assessed the influence of AA supplementation on hospitalization outcomes for community geriatric patients.
Methods: Single-center, retrospective study of community-dwelling patients older than 65-years old admitted to a community hospital from 2010 to 2021. Inclusion criteria: patients older than 65-yo with a stay other than observation/outpatient status. Exclusion criteria: patients needing ICU care, residential-care individuals, patients with COVID-19, and those with terminal diagnoses. Primary outcome: length of hospital stay; secondary outcomes: discharge destination and mortality. 330 patients were randomized into two cohorts. The treatment group had AA with a dosage of 500 mg to 1g/day in addition to hospital pharmacotherapy. The control group received no AA. We tracked patients for 12 weeks following discharge to ascertain survival vs. dead status. Covariates We included age, sex, diagnoses of admission, medications to derive the anticholinergic load -excluding topical, ophthalmic, otologic, and nebulized medications-, and the LOS. ICD-10 codes were used to calculate the Elixhauser comorbidity index. Statistical Analyses Categorical variables are compared with the X2 test; while continuous variables with the ANOVA. We used adjusted multivariate logistic regression to describe correlations of interest with LOS adjusted for age, sex, anticholinergic load, diagnosis of admission, and comorbidities. Odds ratios (OR) with 95% CI are shown for comparative variables, and risk ratio (RR) with 95% CI for the reported mortality.
Results: 330 participants were included (age 76, SE 0.60, 60% female) with a mean anticholinergic load of 3.5 for both groups (SE 0.18). The Elixhauser score was 12 (SE 0.60) for AA patients, and 9.72 (SE 0.59) for control participants (Table 1). AA patients were sicker with higher acuity diagnoses. The control group overall had a less burden of infectious diagnoses (Table 2). Primary Outcome The LOS for AA patients was 6.97 days (SE 0.36) and 5.44 (SE 0.29) for the control group. Regression analysis adjusted for the Elixhauser score, admission diagnoses, age, sex, and anticholinergic load, disclosed that only the anticholinergic load was strongly associated with the LOS; AA group: adjusted OR (aOR) 1.34 (95% CI, 1.37-2.58); p <.001. Non-AA group: aOR 1.48 (95% CI, 1.48-2.31), p <.001.Secondary Outcome From the AA group, 72% of females went home as opposed to 65% of male participants; aOR 1.38 (95% CI, 0.71-2.67). From the non-AA cohort, 84% males were discharged home and 72% in the female group; aOR 1.98 (95% CI, 0.86-4.53). 15.8% in the AA-arm died and 21.2% in the control group. Patients with an Elixhauser score above 13 had a 14% mortality in the AA group. The non-AA group had more deceased in the lower Elixhauser subgroup (=< 12 points), 12%. On Cox Regression analysis, only the Elixhauser variable correlated with mortality: AA-group, HR 1.083 (95% CI 1.02-1.14); non-AA-group HR 1.07. The higher mortality in the non-AA group was reflected on the adjusted risk ratio (aRR), 1.74 (95% CI 0.61-2.98).
Conclusions: There is an association between AA deficiency and post-hospital complications. The present study illustrates an increased 3-month mortality in the control group. In light of the low cost of AA replacement and the few side effects, supplementation should be considered in those at-risk for AA deficiency.