Impact of N-Acetylcysteine in the mortality of patients hospitalized with COVID-19: a retrospective cohort study

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 singlecenter 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. The 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 multi-variate analysis through logistic regression identified the age of patients [older than 80; OR: 8.4 (95% CI: 3-23.4)], a moderate or severe radiologic affectation measured by the RALE score [OR: 7.3 (95% CI: 3.2-16.9)], the tobacco consumption [OR: 2.8 (95% CI: 1.3-6.1)] and previous arrhythmia [OR 2.8 (95% CI: 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 (95% CI: 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 (95% CI: 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. (c) 2023 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.