N-acetylcysteine (NAC) in the complex treatment of COVID-associated pneumonia

Abstract

Background: The pharmacological activity of NAC and its potential effects in suppressing the progression of COVID-19 make it a promising therapeutic agent in COVID-19.

Aims and objectives: To evaluate the efficacy of NAC in the complex treatment of COVID-associated pneumonia.

Methods: In this open-label study 46 patients with COVID-associated moderately severe pneumonia (age was 57,9±12,73 years, disease duration before admission 7,3±1,64 days, body temperature at admission 37,5±0,43 C, lung damage on quantitative chest CT 44±6,46%, oxygenation index (SpO2/FiO2) – 253±19),were randomized into 2 groups: Group 1 (n=22) received standard treatment for COVID-19; Group 2 (n=24) in addition received NAC 1200-1500 mg/day intravenously. Clinical laboratory examination and chest CT scan were performed on the 1st and 10th days of observation.

Results: After the treatment we observed significantly higher increase in blood oxygen saturation (SpO2) and SpO2/FiO2 in NAC group compared to control group: 97(96;98)% vs. 96(96;97)% (p=0,02) and 459 (399;476) vs. 401(331;451) (p=0,03), respectively. The delta of growth in SpO2/FiO2 was significantly higher in NAC group: 175±54,3 & 144±54,4 (p=0,02). The delta of receding percent of lung damage in CT scan was 14±3,94% in NAC group vs. 6,9±2,56% in the control group (p<0,001). We observed a steeper decrease of C-reactive protein levels in NAC group over 10 days of treatment: 90±10,2% vs. 82±13,9% (p=0,03). The addition of NAC to standard therapy was associated with reduced duration of hospital stay (p<0,001).

Conclusions: The findings of the study demonstrate the effectiveness of including NAC in the complex treatment of COVID-associated pneumonia of medium severity.