N-acetylcysteine efficacy in patients hospitalized with COVID-19 pneumonia: a systematic review and meta-analysis.

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Romanian Journal of Internal Medicine Pub Date : 2023-03-01 DOI:10.2478/rjim-2023-0001
Themistoklis Paraskevas, Anastasios Kantanis, Iosif Karalis, Christos Michailides, Vasileios Karamouzos, Ioanna Koniari, Charalampos Pierrakos, Dimitrios Velissaris
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引用次数: 5

Abstract

Background: N-acetylcysteine (NAC) is a mucolytic agents with anti-inflammatory properties that has been suggested as an adjunctive therapy in patients with COVID-19 pneumonia.

Objectives: We conducted a systematic review and meta-analysis to evaluate available evidence on the possible beneficial effects of NAC on SARS-CoV-2 infection.

Methods: In September 2022, we conducted a comprehensive search on Pubmed/Medline and Embase on randomized controlled trials (RCTs) and observational studies on NAC in patients with COVID-19 pneumonia. Study selection, data extraction and risk of bias assessment was performed by two independent authors. RCTs and observational studies were analyzed separately.

Results: We included 3 RCTs and 5 non-randomized studies on the efficacy of NAC in patients with COVID-19, enrolling 315 and 20826 patients respectively. Regarding in-hospital mortality, the summary effect of all RCTs was OR: 0.85 (95% CI: 0.43 to 1.67, I2=0%) and for non-randomized studies OR: 1.02 (95% CI: 0.47 to 2.23, I2=91%). Need for ICU admission was only reported by 1 RCT (OR: 0.86, 95% CI:0.44-1.69, p=0.66), while all included RCTs reported need for invasive ventilation (OR:0.91, 95% CI:0.54 to 1.53, I2=0). Risk of bias was low for all included RCTs, but certainty of evidence was very low for all outcomes due to serious imprecision and indirectness.

Conclusion: The certainty of evidence in the included studies was very low, thus recommendations for clinical practice cannot be yet made. For all hard clinical outcomes point estimates in RCTs are close to the line of no effect, while observational studies have a high degree of heterogeneity with some of them suggesting favorable results in patients receiving NAC. More research is warranted to insure that NAC is both effective and safe in patients with COVID-19 pneumonia.

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n -乙酰半胱氨酸在COVID-19肺炎住院患者中的疗效:一项系统综述和荟萃分析
背景:n -乙酰半胱氨酸(NAC)是一种具有抗炎特性的粘液溶解剂,已被建议作为COVID-19肺炎患者的辅助治疗药物。目的:我们进行了一项系统回顾和荟萃分析,以评估NAC对SARS-CoV-2感染可能有益的现有证据。方法:我们于2022年9月在Pubmed/Medline和Embase上全面检索了COVID-19肺炎患者NAC的随机对照试验(rct)和观察性研究。研究选择、数据提取和偏倚风险评估由两位独立作者完成。随机对照试验和观察性研究分别进行分析。结果:我们纳入了3项随机对照试验和5项非随机研究,分别纳入315例和20826例患者。关于住院死亡率,所有随机对照试验的总效应OR为0.85 (95% CI: 0.43 ~ 1.67, I2=0%),非随机研究的OR为1.02 (95% CI: 0.47 ~ 2.23, I2=91%)。只有1项RCT报告了ICU住院的需要(OR: 0.86, 95% CI:0.44-1.69, p=0.66),而所有纳入的RCT报告了有创通气的需要(OR:0.91, 95% CI:0.54 - 1.53, I2=0)。所有纳入的随机对照试验的偏倚风险都很低,但由于严重的不精确性和间断性,所有结果的证据确定性都很低。结论:纳入的研究证据的确定性很低,尚不能对临床实践提出建议。对于所有硬临床结局,随机对照试验的估计点都接近于无效果线,而观察性研究具有高度的异质性,其中一些研究表明接受NAC的患者有良好的结果。有必要进行更多的研究,以确保NAC对COVID-19肺炎患者既有效又安全。
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来源期刊
Romanian Journal of Internal Medicine
Romanian Journal of Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.20
自引率
5.30%
发文量
35
审稿时长
15 weeks
期刊介绍: Romanian Journal of Physics is a journal publishing physics contributions on the following themes: •Theoretical Physics & Applied Mathematics •Nuclear Physics •Solid State Physics & Materials Science •Statistical Physics & Quantum Mechanics •Optics •Spectroscopy •Plasma & Lasers •Nuclear & Elementary Particles Physics •Atomic and Molecular Physics •Astrophysics •Atmosphere and Earth Science •Environment Protection
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