Efficacy of N-acetyl Cysteine in Severe COVID-19 Patients: A Randomized Controlled Phase III Clinical Trial

Background: Today, various drugs have been investigated as the primary or complementary treatment for coronavirus disease 2019 (COVID-19). N-acetylcysteine (NAC) has used a mucolytic in pulmonary diseases. This drug apparently contributes to retrieval of intracellular antioxidant system. Objectives: study aimed determine efficacy NAC severe COVID-19 patients admitted intensive care unit (ICU). Methods: single-blinded randomized controlled phase III clinical trial included 40 with confirmed (based on polymerase chain reaction) Shahid Mohammadi Hospital’s ICU, Bandar Abbas, Iran, 2020. All cases had COVID-19. They were allocated randomly two equal groups. Patients control group received standard therapy based protocol national committee, while those single dose intravenous (300 mg/kg) upon admission ICU addition treatment. Clinical status and laboratory tests done then 14 days later at discharge without knowing patient grouping. Results: The groups comparable regarding age, gender, other baseline parameters. At final evaluation, respiratory rate (21.25 ± 4.67 vs. 27.37 6.99 /min) D-dimer (186.37 410.23 1339.04 2183.87 ng/mL) significantly lower (P = 0.004 P 0.030, respectively). Also, percentage lactate dehydrogenase (LDH) ≤ 245 U/L (0% 25%, 0.047). Although length ward stay was shorter than controls, difference statistically insignificant 0.598 0.629, Mortality, hand, 75% 50% group, no significant 0.102). Concerning change parameters, only decrease diastolic blood pressure (DBP) higher 0.042). intubation mechanical ventilation rates higher, oxygen mask nasal NAC, but insignificant. Conclusions: Based current research, is related RR, D-dimer, DBP LDH controls. More research larger sample sizes needed validate results.