Abstract
Infection by SARS-CoV-2 causing coronavirus disease 2019 (COVID-19) can be associated with serious and life-threatening conditions, including acute respiratory distress syndrome (ARDS). Severity and mortality have been related to a cytokine storm, an imbalance of oxidative stress, and a pro-thrombotic state.We conducted an observational retrospective cohort study from a community-based large population of hospitalized COVID-19 PCR + patients admitted from March 01, 2020, to January 24, 2021, with integrated primary to tertiary care information in Castilla la Mancha, Spain. We explored the potential benefits of the antioxidant, anti-inflammatory and anti-thrombotic drug N-acetylcysteine (NAC) administered orally in high doses (600 mg every 8 h), added to standard of care in COVID-19 patients by using the free text information contained in their electronic health records (EHRs).Out of 19,208 patients with a diagnosis of COVID-19 hospitalized, we studied 2071 (10.8%) users of oral NAC at high doses. COVID-19 patients treated with NAC were older, predominantly male, and with more comorbidities such as hypertension, dyslipidemia, diabetes, and COPD when compared with those not on NAC (all p < 0.05). Despite greater baseline risk, use of NAC in COVID-19 patients was associated with significantly lower mortality (OR 0.56; 95%CI 0.47-0.67), a finding that remained significant in a multivariate analysis adjusting by baseline characteristics and concomitant use of corticosteroids. There were no significant differences with the use of NAC on the mean duration of hospitalization, admission to the intensive care unit or use of invasive mechanical ventilation. The observed association signaling to better relevant outcomes in COVID-19 patients treated with NAC at high doses should be further explored in other settings and populations and in randomized controlled trials.
Keywords: COVID-19; N-acetylcysteine; mortality; treatment; use of health services.
【저자키워드】 COVID-19, Treatment, Mortality, N-acetylcysteine, use of health services., 【초록키워드】 coronavirus disease, SARS-CoV-2, ARDS, Cytokine storm, High dose, Corticosteroids, Randomized controlled trials, Hospitalized, intensive care, Anti-inflammatory, Comorbidity, risk, diabetes, oxidative stress, outcome, hypertension, antioxidant, Population, Electronic health record, COPD, PCR, Health services, male, Patient, Spain, information, Admission, Care, association, acute respiratory distress, Signaling, Invasive mechanical ventilation, Analysis, COVID-19 patient, Standard of care, retrospective cohort study, Older, 95%CI, no significant difference, baseline characteristics, syndrome, life-threatening, doses, concomitant use, significantly lower, hospitalized COVID-19, Administered, duration of hospitalization, NAC, greater, remained, conducted, treated, added, potential benefit, conditions, the mean, baseline, diagnosis of COVID-19, pro-thrombotic, 【제목키워드】 High dose, patients hospitalized, with COVID-19,