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Vol. 223. Issue 8.
Pages 479-485 (October 2023)
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Vol. 223. Issue 8.
Pages 479-485 (October 2023)
Original article
Impact of N-Acetylcysteine in the mortality of patients hospitalized with COVID-19: a retrospective cohort study
Efecto de la N-Acetilcisteína en la mortalidad de pacientes ingresados por COVID-19: estudio de cohorte retrospectivo
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M.A. Galindo-Andúgara,
Corresponding author
magalindo@sescam.jccm.es

Corresponding author.
, Á. Arias Ariasb, J. Alfonso García Guerrac, I. Fernández Visierd, J. Manuel Fernández Ibáñeze, A. Bellido Maldonadoc
a Servicio de Medicina Interna. Hospital General La Mancha Centro, Alcázar de San Juan (C. Real), Spain
b Unidad de Docencia, Investigación y Formación, Hospital General La Mancha Centro, Alcázar de San Juan (C. Real), Spain
c Sección de Neumología, Hospital General La Mancha Centro, Alcázar de San Juan (C. Real), Spain
d Sección de Aparato Digestivo, Hospital General La Mancha Centro, Alcázar de San Juan (C. Real), Spain
e Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan (C. Real), Spain
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Tables (3)
Table 1. Main characteristics of patients included in the study and comparison between patients who did and did not receive NAC.
Table 2. Clinical characteristics, radiological findings, and treatment regimens and comparison between patients who did and did not receive NAC.
Table 3. Multivariate analysis of risk factors of mortality, adjusted for the main comorbidities.
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Abstract
Introduction and aim

N-Acetylcysteine has been proposed for the treatment of COVID-19 thanks to its mucolytic, antioxidant and anti-inflammatory effects. Our aim is to evaluate its effect on patients admitted with COVID-19 in mortality terms.

Material and methods

Retrospective single-center cohort study. All patients admitted to our hospital for COVID-19 from March to April 2020 have been considered.

Results

A total of 378 patients were included, being 196 (51.9%) men, with an average age of 73.3±14.5 years. 52.6% (199) received treatment with N-Acetylcysteine. More than 70% presented coughs, fever, and/or dyspnea. The global hospital mortality was 26.7%. A multivariate analysis through logistic regression identified the age of patients [older than 80; OR: 8.4 (CI95%:3−23.4)], a moderate or severe radiologic affectation measured by the RALE score [OR:7.3 (CI95%:3.2–16.9)], the tobacco consumption [OR:2.8 (CI95%:1.3–6.1)] and previous arrhythmia [OR 2.8 (CI95%: 1.3–6.2)] as risk factor that were independently associated with mortality during the admission. The treatment with N-Acetylcysteine was identified as a protective factor [OR: 0.57 (CI95%: 0.31−0.99)]. Asthma also seems to have a certain protective factor although it was not statistically significant in our study [OR: 0.19 (CI95%: 0.03–1.06)].

Conclusions

Patients with COVID-19 treated with N-acetylcysteine have presented a lower mortality and a better evolution in this study. Future prospective studies or randomized clinical trials must confirm the impact of N-Acetylcysteine on COVID-19 patients.

Keywords:
N-Acetylcysteine
COVID-19
SARS-CoV-2
Hospital mortality
Resumen
Introducción y objetivo

La N-Acetilcisteína se ha propuesto para el tratamiento de COVID-19 gracias a sus efectos mucolítico, antioxidante y antiinflamatorio. El presente estudio tiene como objetivo evaluar su efecto en pacientes ingresados con COVID-19, en términos de mortalidad.

Material y métodos

Estudio de cohorte retrospectivo unicéntrico. Se incluyeron todos los pacientes ingresados por COVD-19 entre marzo y abril de 2020 en nuestro hospital.

Resultados

Un total de 378 pacientes fueron incluidos, de ellos 196 (51,9%) fueron hombres, la edad media fue de 73,3±14,5 años. 199 (52,6%) pacientes recibieron tratamiento con N-Acetilcisteína. Más del 70% tuvieron tos, fiebre y/o disnea. La mortalidad hospitalaria global fue del 26,7%. Un análisis multivariante mediante regresión logística identificó la edad de los pacientes [mayores de 80 años; OR: 8,4 (IC95%: 3–23,4)], una afectación radiológica moderada o grave medida por la escala RALE [OR: 7,3 (IC95%: 3,2–16,9)], el consumo de tabaco [OR: 2,8 (IC95%: 1,3–6,1)] y arritmia previa [OR: 2,8 (IC95%: 1,3–6,2)] como factores de riego que se asociaron independientemente con la mortalidad durante el ingreso. El tratamiento con N-acetilcisteína fue identificado como factor protector [(OR: 0,57 (IC95%: 0,31–0,99)]. El asma podría representar asimismo un factor protector de mortalidad, aunque en el presente estudio no alcanza significación estadística [(OR: 0,19 (IC95%: 0,03–1,06)].

Conclusiones

Los pacientes con COVID-19 tratados con N-Acetilcisteína presentaron una menor mortalidad y mejor evolución en nuestro estudio. Futuros estudios prospectivos o ensayos clínicos aleatorizados deben confirmar el papel de la N-Acetilcisteína en pacientes con COVID-19.

Palabras clave:
N-Acetilcisteína
COVID-19
SARS-CoV-2
Mortalidad hospitalaria

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