N-acetyl-cysteine cuts risk for mechanical ventilation, mortality in COVID-19 pneumonia

 Stelios F. Assimakopoulosa Department of Internal Medicine, University of Patras Medical School, Patras, GreeceCorrespondencesassim@upatras.gr

https://orcid.org/0000-0002-6901-3681

,

Diamanto Arethab Department of Anesthesiology and Intensive Care Medicine, University of Patras Medical School, Patras, Greece

,

Dimitris Komninosc Department of Internal Medicine, “St Andrews” State General Hospital, Patras, Greece

,

Dimitra Dimitropoulouc Department of Internal Medicine, “St Andrews” State General Hospital, Patras, Greece

,

Maria Lagadinoua Department of Internal Medicine, University of Patras Medical School, Patras, Greece

,

Lydia Leonidoua Department of Internal Medicine, University of Patras Medical School, Patras, Greece

,

Ioanna Oikonomoua Department of Internal Medicine, University of Patras Medical School, Patras, Greece

,

Athanasia Mouzakid Division of Hematology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece

&

Markos Marangosa Department of Internal Medicine, University of Patras Medical School, Patras, Greece

show all

Pages 847-854 | Received 25 May 2021, Accepted 16 Jun 2021, Published online: 29 Jun 2021

DOI: https://doi.org/10.1080/23744235.2021.1945675

PDF: https://www.tandfonline.com/doi/full/10.1080/23744235.2021.1945675?scroll=top&needAccess=true

Abstract

Background

N-acetyl-cysteine (NAC) has been previously shown to exert beneficial effects in diverse respiratory diseases, through antioxidant and anti-inflammatory actions. Our aim was to evaluate NAC potential impact in hospitalised patients with COVID-19 pneumonia, in terms of progression to severe respiratory failure (SRF) and mortality.

Patients and Methods

This retrospective, two-centre cohort study included consecutive patients hospitalised with moderate or severe COVID-19 pneumonia. Patients who received standard of care were compared with patients who additionally received NAC 600 mg bid orally for 14 days. Patients’ clinical course was recorded regarding (i) the development of SRF (PO₂/FiO₂ <150) requiring mechanical ventilation support and (ii) mortality at 14 and 28 days.

Results

A total of 82 patients were included, 42 in the NAC group and 40 in the control group. Treatment with oral NAC led to significantly lower rates of progression to SRF as compared to the control group (p < .01). Patients in the NAC group presented significantly lower 14- and 28-day mortality as compared to controls (p < .001 and p < .01 respectively). NAC treatment significantly reduced 14- and 28-day mortality in patients with severe disease (p < .001, respectively). NAC improved over time the PO2/FiO2 ratio and decreased the white blood cell, CRP, D-dimers and LDH levels. In the multivariable logistic regression analysis, non-severe illness and NAC administration were independent predictors of 28-days survival.

Conclusion

Oral NAC administration (1200 mg/d) in patients with COVID-19 pneumonia reduces the risk for mechanical ventilation and mortality. Our findings need to be confirmed by properly designed prospective clinical trials.

Disclosure statement

The authors declare that they have no conflict of interest.

https://www.tandfonline.com/doi/abs/10.1080/23744235.2021.1945675?journalCode=infd20