title: The relationship between acute changes in the systemic inflammatory response and plasma ascorbic acid, alpha-tocopherol and lipid peroxidation after elective hip arthroplasty.
abstract: OBJECTIVE
  Vitamin C (ascorbic acid, AA) is a water soluble vitamin with many functions including antioxidative properties, haemostasis, hormone synthesis, collagen synthesis, carnitine synthesis, bile salt production and enhancing iron absorption. There is some evidence that there is a negative inverse relationship between plasma vitamin C concentration and the systemic inflammatory response as measured by C-reactive protein (CRP). The aim of the present study was to examine, in the context of a longitudinal study, the change in plasma concentrations of ascorbic acid (AA) and Vitamin E (α-tocopherol, AT) and their relationship to free radical damage during the evolution of the systemic inflammatory response.
  
  
  METHODS
  Venous blood samples were obtained pre-operatively and at 1, 2, 3 and 90 days post-operatively from 11 patients undergoing elective hip arthroplasty at Glasgow Royal Infirmary. AA, AT, cholesterol, MDA (marker of free radical damage), CRP and albumin were measured in plasma.
  
  
  RESULTS
  Plasma AA fell significantly by 74% (P < 0.01), AT fell by 36% (P < 0.01), cholesterol by 40% (P < 0.01), MDA by 38% (P < 0.01), albumin by 29% (P < 0.01) and CRP increased significantly by 160 fold (P < 0.01) during the systemic inflammatory response. The fall in plasma AA remained significant when adjusted for albumin (P < 0.01). Plasma AT adjusted for cholesterol did not change significantly during the study period. The fall in plasma MDA remained significant when adjusted for albumin (P 0.01). At 3 months post-operatively, all measurements (including AA) except albumin had returned to baseline values.
  
  
  CONCLUSIONS
  Plasma AA levels are unlikely to be a reliable measurement of Vitamin C where there is evidence of a systemic inflammatory response. The decrease in plasma AA concentration is likely to be secondary to increased consumption, increased usage neutralising free radicals, increased utilisation in supporting AT regeneration and increased urinary excretion.
authors.affiliation: Academic Unit of Surgery, College of Medical, Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Glasgow, G4 0SF, United Kingdom. Electronic address: fconway@nhs.net.
authors.forename: F J S
authors.initials: FJ
authors.lastname: Conway
authors.affiliation: The Scottish Trace Element and Micronutrient Laboratory, Department of Biochemistry, Royal Infirmary Glasgow, G4 0SF, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Talwar
authors.affiliation: Academic Unit of Surgery, College of Medical, Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Glasgow, G4 0SF, United Kingdom.
authors.forename: D C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000328:Adult; D000368:Aged; D001178:Arthroplasty; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D005260:Female; D006615:Hip / Q000601:surgery*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D015227:Lipid Peroxidation / Q000187:drug effects*; D008137:Longitudinal Studies; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D012709:Serum Albumin / Q000378:metabolism; D024502:alpha-Tocopherol / Q000008:administration & dosage / Q000097:blood*
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D008315:Malondialdehyde; D002097:C-Reactive Protein; D002784:Cholesterol; D024502:alpha-Tocopherol; D001205:Ascorbic Acid
keywords: CRP; Free radical damage; Inflammation; Vitamin C; Vitamin E