Coenzyme Q10 in sepsis patients

reference

Soltani r, Alikiaie B, Shafiee F, Amiri H, Mousavi S. Coenzyme Q10 improves survival and reduces inflammatory markers in septic patients. Bratislava Lek Listy . 2020; 121 (2): 154-158.

Study goal

Assessment of the effect of Coenzyme Q10 (COQ10) on inflammatory markers, assessment of the organ failure, duration of the stay in the intensive care unit (ICU) and hospital mortality in patients in the early phase of sepsis, the routine supply plus COQ10 only receive routine care

draft

prospective, randomized study

participant

The test doctors examined successive patients who were recorded in the intensive care unit of a university hospital in Isfahan, Iran, and assigned 57 patients to either the control group (n = 28) or the intervention group (n = 29). Forty (n = 40) patients (20 in each arm) ended the study, which included 31 men and 9 women. The average age of the intervention group was 47.8 ± 22 years, while the average age of the control group was 55.6 ± 19.4 years. The inflammatory and oxidative Baseline markers between the groups were not significantly different.

inclusion criteria were:

• old ≥18 years
• present of 2 or more of the 4 criteria of the systemic inflammatory reaction syndrome (SIRS):

1. heart rate> 90 blows/min
2. Breathing rate> 20 breaths/min or carbon dioxide partial pressure (paco _{2 ) <32 mmHg}
3. suspected or confirmed infection: white blood cells (WBC)> 12,000 cells/mm 3 or <4,000 cells/mm 3 or> 10 % immature (gang) cells
4. Apache (Acute Physiologic Assessment and Chronic Health Evaluation) II scores more than 15 points during the recording. The Apache II score is a calculation of laboratory and clinical findings to estimate mortality in the intensive care unit. ¹

exclusion criteria were:

• Koagulopathy, defined as an INR (International Normalized Ratio)> 2
• Current use of Coenzyme Q10 or other antioxidants

The study also ruled out patients who could not receive enteral medication, were pregnant, currently participating in other studies or orders in the final stage or for non-re-resurrection (DNR).

study parameters evaluated

The participants received either 100 mg coenzyme Q10 (Ubichinon) twice a day for 7 days and the standard supply for sepsis or the standard supply for sepsis alone. The standard supply for sepsis includes early revival within the first 6 hours after the admission, diagnostic studies on determining the pathogen and broadband antibiotic therapy with subsequent microbiological tests.

Primary result measurements

Primary endpoints were changes in inflammation, measured based on the concentrations of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α). The primary endpoints also included oxidative damage, determined by Malondiahyde (MDA) and glutathione peroxidase. The researchers measured these markers at the beginning of the study, on day 3 and on day 7 both in the intervention and control arm.

The mortality rate in the hospital was 20 % for the COQ10 group and 65 % for the control group.

During the procedure only 7 days, the patients remained in the hospital until they could be released or died. Therefore, the secondary endpoints included the duration of the hospital stay and the mortality rate in the hospital. The sequential organ failure assessment (sofa) score and the simplified acute physiology score (SAPS II) were also secondary endpoints.

important knowledge

Two of the 4 inflammatory markers showed improvements.

Receives from TNF-α ( p = 0.003) and MDA ( p = 0.003) on the 7th day in the group, the Coenzyme Q10 was observed compared to the control group and at the starting value.

The IL-6 levels were also reduced compared to the starting value and between the arms; However, this finding did not achieve statistical significance ( p = 0.22). During the 7-day study, no change in the glutathione peroxidase was found between the two groups. The mortality rate in the hospital was 20 % for the COQ10 group and 65 % for the control group ( p = 0.01).

Secondary endpoints: Coenzyme Q10 did not change the sofa or SAPS II scores during the 7-day study period. The length of stay in the intensive care unit does not differ significantly between the two groups.

practice implications

This study offers a modest intervention with modest results for a population that at first glance does not seem to be entirely relevant to outpatient clinical practice. Regardless of these characteristics, there can be some nuanced snack bars for those who work in naturopathic practice.

Coenzyme Q10 is often used in neurological cases with the understanding that it supports mitochondrial function and in return improve the clinical results, especially if a defect is determined or suspected. This study brings further awareness of the role of mitochondrial function in immunocompromised persons, another population that may tend to be COQ10 deficiency.

Treatment of patients with sepsis often focuses on macro -circular resuscitation through treatment with liquids and/or blood transfusions and/or inotropic. Cells must be able to use energy substrates in order to correctly form adenosintriphosphate (ATP). If this is not the case, cytopenic hypoxia can result and a partial or complete organ failure can result. It is known that COQ10 plays an important role in the electron transport chain. In particular, it serves as the carrier of electrons from the complex I and II to complex III. Cell breathing in mitochondria can be impaired if this mechanism is disturbed, which leads to a reduced intracellular ATP production.

A characteristic of this study that practitioners may notice is the rather low dose of COQ10 used in these sick patients; 200 mg COQ10 can be a usual, typical daily dose, if not on the low side that is used in outpatient care. Treatment of mitochondrial myopathies can begin with doses of 400 mg per day. ^{6 In the Q-symbio study, 420 patients with chronic heart failure of functional class III or IV of the NYHA (New York Heart Association) received 300 mg COQ10 plus standard therapy every day. Other clinical studies have used much higher doses of COQ10 in various patient populations, including 1,200 mg and 2,400 mg in patients with Parkinson's disease 8 and up to 3,000 mg in patients with amyotrophic lateral sclerosis (as). The description of Coenzyme Q10 in the publication suggests the use of Ubichinon compared to the reduced form of ubiquinol, which could also catch up with a practitioner. This feature is particularly interesting, since 200 mg ubiquinol was used twice a day in a similar patient population in an earlier pilot study. 10 It is assumed that ubiquinol increases the plasma levels from Ubichinon better than Ubichinon itself. Admission (oral or nasogastral probe) depended on the patient's skills.}

Systemic infections, as they are present in the population examined, often require heroic interventions, such as implies the admission in the intensive care unit in this study. However, the effects on the practice that are relevant for care outside the hospital could be the use of COQ10 in the patients in whom there is the greatest risk of sepsis complications. The Centers for Disease Control and Prevention emphasize a few patient populations with the greatest risk, including people aged 65 and over, people with chronic diseases such as diabetes, lung diseases, cancer and kidney diseases as well as people with a weakened immune system systems, and also those who have survived a sepsis episode. Mitochondria as an intervention goal in the early treatment of sepsis and possibly preventing a misconception of the immune system is an attractive knowledge from a study like this. In view of the fact that the dosage area of ​​oral administration is wide, higher doses may be necessary to achieve the intended clinical results. Future studies will undoubtedly expand our understanding of the use of Coenzyme Q10 and other nutrients to support mitochondria in immune -dependent diseases such as sepsis.

disclosure of conflicts of interest

The author is an employee of integrative therapeutics that benefits from the sale of Coenzyme Q10 products.