N-acetylcysteine reduces severity and mortality in COVID-19 patients: A systematic review and meta-analysis.

Authors

  • Mohammad Shah Alam Department of Anatomy and Histology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh. https://orcid.org/0000-0003-2657-9121
  • Mohammad Nazmol Hasan Department of Statistics, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh. https://orcid.org/0000-0003-4268-8774
  • Zannatul Maowa Department of Anatomy and Histology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh.
  • Fahima Khatun Department of Pathobiology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh.
  • K H M Nazmul Hussain Nazir Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh. https://orcid.org/0000-0002-3893-754X
  • Mohammad Zahangeer Alam Department of Environmental Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh. https://orcid.org/0000-0001-9407-0306

Keywords:

N-Acetylcysteine; COVID-19; SARSCoV-2;severity; mortality; treatment

Abstract

Objectives: Recent clinical studies suggest that oxidative stress is one of the key players in the pathogenesis of coronavirus disease 2019 (COVID-19), and N-acetylcysteine (NAC), a potent antioxidant, has been shown to improve clinical outcomes in COVID-19 patients. We conducted a systematic review and meta-analysis of the literature published on the therapeutic intervention of NAC on COVID-19 infection. Methods: We searched PubMed, Google Scholar, and Science Direct. We identified and screened eight studies with 20,503 participants, including 2,852 in the NAC-treated group and 17,651 in the placebo group, which reported the effect of NAC on COVID-19 infection. A meta-analysis was performed using forest plots under fixed effect estimates based on the standardized mean difference (SMD) and risk ratio (RR). Results: Pooled analysis showed that NAC was associated with lower mortality in patients with COVID-19 compared with the placebo group [RR, 0.65; (95% CI: 0.56 to 0.75); p < 0.0001]. Similarly, C-reactive protein (CRP) [SMD, −0.32; (95% CI: −56 to −0.09); p = 0.0070] and D-dimer [SMD, −0.35, (95% CI: −0.59 to −0.10; p = 0.0062] levels were significantly decreased, and the oxygenation marker, PaO2 /FiO2 ratio, was increased in the NAC-treated group compared with the placebo group [SMD, 0.76; (95% CI: 0.48 to 1.03); p < 0.0001]. Conclusion: Although the number of included studies was minimal, this meta-analysis suggests that NAC may have a positive effect on COVID-19 outcomes, specifically, a significant decrease in CRP and D-dimer levels and a significant increase in oxygen saturation, which decreased mortality. We have also presented a comprehensive review of the role and mechanisms of NAC in patients with COVID-19.

J. Adv. Vet. Anim. Res., 10(2): 157–168, June 2023

http://doi.org/10.5455/javar.2023.j665

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Published

2023-06-30

How to Cite

Alam, M. S., Hasan, M. N., Maowa, Z., Khatun, F., Nazir, K. H. M. N. H., & Alam, M. Z. (2023). N-acetylcysteine reduces severity and mortality in COVID-19 patients: A systematic review and meta-analysis. Journal of Advanced Veterinary and Animal Research, 10(2), 157–168. Retrieved from https://banglajol.info/index.php/JAVAR/article/view/80383

Issue

Vol. 10 No. 2 (2023)

Section

Original Articles

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Copyright (c) 2023 Mohammad Shah Alam, Mohammad Nazmol Hasan, Zannatul Maowa, Fahima Khatun, K H M Nazmul Hussain Nazir, Mohammad Zahangeer Alam

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