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Intern Med J. 2019 Feb;49(2):189-196. doi: 10.1111/imj.14030.

Vitamin C deficiency in Australian hospitalised patients: an observational study.

Author information

Department of General Medicine, Flinders Medical Centre, Flinders Drive, South Australia, Australia.
College of Medicine and Public Health, Flinders University, Flinders Drive, South Australia, Australia.
Department of Nutrition and Dietetics, Flinders University, South Australia, Australia.
Department of Clinical Epidemiology, Flinders Medical Centre, South Australia, Australia.
Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.



Vitamin C has anti-oxidant properties and acts as a cofactor for several enzymes. Hypovitaminosis C has been associated with bleeding, endothelial dysfunction and death. The prevalence of hypovitaminosis C is unknown in Australian hospitalised patients, and its clinical relevance is uncertain.


To determine the prevalence, characteristics and clinical outcomes of hospitalised patients with hypovitaminosis C.


This observational study included general-medical inpatients in a tertiary-level hospital in Australia. High-performance liquid chromatography (HPLC) was used to determine plasma vitamin C levels. As per Johnston's criteria, vitamin C levels of ≥28 μmol/L were classified as normal and <28 μmol/L as low. Clinical outcomes determined included length of hospital stay (LOS), nosocomial complications, intensive care unit admission and in-hospital mortality.


A total of 200 patients participated in this study, and vitamin C levels were available for 149 patients, of whom 35 (23.5%) had normal vitamin C levels, and 114 (76.5%) had hypovitaminosis C. Patients with hypovitaminosis C were older and had higher C-reactive protein (CRP) levels. Median LOS was 2 days longer in patients with hypovitaminosis C (6 days (interquartile range (IQR) 4, 8) vs 4 days (IQR 3, 6), P = 0.02), and they had fourfold higher odds of staying in hospital for >5 days than those with normal vitamin C levels. Other clinical outcomes were similar between the two groups.


Hypovitaminosis C is common in hospitalised patients and is associated with prolonged LOS. Further research is needed to ascertain the benefits of vitamin C supplementation in vitamin C-depleted patients.


clinical outcomes; hospitalised patients; prevalence; vitamin C

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