Effect of Intravenous N-acetylcysteine on Prevention of Mechanical Ventilation and Mortality among COVID-19 Patients: A Meta-Analysis

BACKGROUND COVID-19 is a looming disease that continuous to challenge medical systems all over the world due to its significant effect on morbidity and mortality. Early in the pandemic and even until present time, repurposing of a known drug significantly hasten the deployment of a novel approach for COVID- 19. One existing medication explored that could potentially provide invaluable treatment for COVID-19 is N-acetylcysteine (NAC) due to its antioxidant, anti-inflammatory and immune-modulating characteristics that has been hypothesized to modulate cytokine storm in patients with COVID-19. OBJECTIVES To investigate the effect of intravenous N-acetylcysteine in the prevention of mechanical ventilation and mortality among COVID-19 confirmed patients. METHODS A comprehensive literature search showed 7 records from which 5 were excluded and only 2 passed the inclusion and exclusion criteria. Two reviewers independently selected studies, assessed quality, and extracted and pooled outcomes. All selected studies were found to be of low risk of bias based on Review Manager Bias Assessment tool. Statistical analysis and forest plot generation were done using the Review Manager Software 5.3. RESULTS Pooled results showed a total of 227 patients in both NAC (n = 114) and control groups (n = 113) of COVID-19. There was no sufficient evidence to show that NAC prevents the need of mechanical ventilation among COVID-19 patients with odds ratio of 0.97 (95% CI, 0.54–1.74) and with p-value of 0.93. There was also no sufficient evidence to show that NAC prevents mortality among COVID-19 patients with odds ratio of 0.87 (95% CI, 0.44–1.7) and with p-value of 0.68. CONCLUSION NAC is an accessible, safe and highly tolerated drug used for many years already in patients with respiratory infection. This study showed that there is no sufficient evidence to prove that NAC prevents mechanical ventilation and mortality among COVID-19 patients and it’s use in resource limited areas cannot be recommended.