Determining the efficacy of N-acetyl cysteine in treatment of pneumonia in COVID-19 hospitalized patients: A meta-analysis

Abstract

Background Most patients infected with COVID-19 experienced cold-like symptoms. Some other patients developed more serious symptoms such as pneumonia. N-Acetylcysteine ​​(NAC) is known to be effective against acute respiratory distress syndrome (ARDS) due to its anti-inflammatory and antioxidant properties. The effect of NAC on hospitalized COVID-19 patients was unknown. Therefore, this meta-analysis aimed to establish a relationship between the effects of NAC and non-NAC protocols in inpatients with COVID-19. Method By March 2022, a systemic review was conducted to assess the effects of NAC and non-NAC in inpatients with COVID-19. The clinical trials were identified in 20553 subjects admitted with COVID-19 at baseline. 2909 was treated with NAC and 17644 was treated without NAC. This study attempts to compare the effects of NAC and non-NAC in COVID-19 patients hospitalized with pneumonia. Statistical analysis uses the dichotomous method as a tool for odds ratio (OR) at  95% confidence interval (CI) to assess the effectiveness of NAC and non-NAC in COVID-19 patients hospitalized with pneumonia in random or fixed-effect model. Results Patients managed with NAC had fewer days in the ICU (OR, 2.79; 95% CI, -1.11-6.69, p = 0.16), lower mortality (OR, 0.69; 95% CI, 0.40-1.20, p = 0.19), and fewer number needed mechanical ventilation (OR, 0.74; 95% CI, 0.25-2.21, p = 0.59) compared with non-NAC in COVID-19 subjects hospitalized with pneumonia. Conclusion NAC has decreased the days stayed in the ICU, number of deaths, and number of patients needed mechanical ventilation in COVID-19 hospitalized with pneumonia, although, this difference was insignificant. Further studies are required that could affect the level of significance.

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