Therapeutic possibilities of using an expectorant mucolytic agent with antioxidant properties in COVID-19 infection
DOI: 10.32364/2587-6821-2021-5-7-473-478
G.L. Ignatova1, V.N. Antonov1, E.V. Sheklanova2, M.A. Korotkaya2, M.V. Domracheva2, S.O. Zotov2
1South Ural State Medical University, Chelyabinsk, Russian Federation
2Regional Clinical Hospital No. 3, Chelyabinsk, Russian Federation
Aim: to study the effect of N-acetylcysteine (NAC) on the dynamics of clinical and radiological changes in patients with COVID-19.
Patients and Methods: the study included 111 patients with moderate and severe forms of COVID-19 pneumonia of the 2nd and 3rd stage according to computed tomography (CT). The median age was 49,25 years. Group 1 (n=55) received standard therapy: favipiravir, enoxaparin sodium according to the regimen, dexamethasone. Antibacterial therapy was conducted according to the indications. In addition to standard therapy, group 2 (n=56) was prescribed with NAC at a daily dose of 1200 mg, intravenously, divided into two doses. All patients underwent a comprehensive examination: WBC count, C-reactive protein (CRP), ferritin, fibrinogen, multispiral computed tomography and ultrasound of the chest organs were determined at admission, on the 7th-10th day of hospitalization, at discharge and 8 weeks after discharge.
Results: initially, patients from both groups were comparable in terms of demographic indicators and condition severity. NAC prescription to the standard therapy showed a more positive trend both in terms of clinical symptoms and laboratory indicators. Respiratory rate, heart rate, and body temperature were statistically significantly lower in group 2 already on the 7th-10th day of follow-up. The levels of CRP, ferritin and fibrinogen also normalized faster in group 2. The periods of stay in the hospital were 15.3 days and 12.2 days, respectively, in patients from groups 1 and 2 (p<0,05).
Conclusions: early prescription with N-acetylcysteine to patients with a moderate course of COVID-19 allowed statistically significantly reducing the volume of lung tissue damage, reducing the level of inflammatory markers (CRP, ferritin, fibrinogen) and contributed to an earlier discharge of the patient.
Keywords: COVID-19, N-acetylcysteine, pneumonia, acute respiratory distress syndrome, cytokine storm.
For citation: Ignatova G.L., Antonov V.N., Sheklanova E.V. et al. Therapeutic possibilities of using an expectorant mucolytic agent with antioxidant properties in COVID-19 infection. Russian Medical Inquiry. 2021;5(7):473–478 (in Russ.). DOI: 10.32364/2587-6821-2021-5-7-473-478.
2. Huang C., Wang Y., Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5.
3. Shi Z., Puyo C.A. N-Acetylcysteine to Combat COVID-19: An Evidence Review. Ther Clin Risk Manag. 2020;16:1047–1055. DOI: 10.2147/TCRM.S273700.
4. Jorge-Aarón R.M., Rosa-Ester M.P. N-acetylcysteine as a potential treatment for COVID-19. Future Microbiol. 2020;15:959–962. DOI: 10.2217/fmb-2020-0074.
5. Thierry A.R. Anti-protease Treatments Targeting Plasmin(ogen) and Neutrophil Elastase May Be Beneficial in Fighting COVID-19. Physiol Rev. 2020;100(4):1597–1598. DOI: 10.1152/physrev.00019.2020.
6. De Flora S., Balansky R., La Maestra S. Rationale for the use of N-acetylcysteine in both prevention and adjuvant therapy of COVID-19. FASEB J. 2020;34(10):13185–13193. DOI: 10.1096/fj.202001807.
7. Hoffmann M., Kleine-Weber H., Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181:271–280.e8. DOI: 0.1016/j.cell.2020.02.052.
8. Wrotek S., Sobocińska J., Kozłowski H.M. et al. New insights into the role of glutathione in the mechanism of fever. Int J Mol Sci. 2020;21:pii: E1393.
9. Inui S., Fujikawa A., Jitsu M. et al. Chest CT Findings in Cases from the Cruise Ship "Diamond Princess" with Coronavirus Disease 2019 (COVID-19). Radiology: Cardiothoracic Imaging. 2020;2(2):e200110. DOI: 10.1148/ryct.2020200110.
10. Lichtenstein D.A. Lung Ultrasound in the Critically Ill. The BLUE Protocol. Cham: Springer; 2016:376. DOI: 10.1186/2110-5820-4-1.
11. Schoeman D., Fielding B.C. Coronavirus envelope protein: current knowledge. Virol J. 2019;16(1):69. DOI: 10.1186/s12985-019-1182-0.
12. Ullian M.E., Gelasco A.K., Fitzgibbon W.R. et al. N-acetylcysteine decreases angiotensin II receptor binding in vascular smooth muscle cells. J Am Soc Nephrol. 2005;16(8):2346–2353. DOI: 10.1681/ASN.2004060458.
13. Boesgaard S., Aldershvile J., Poulsen H.E. et al. N-acetylcysteine inhibits angiotensin converting enzyme in vivo. J Pharmacol Exp Ther. 1993;265(3):1239–1244.
14. McCarty M.F., DiNicolantonio J.J. Nutraceuticals have potential for boosting the type 1 interferon response to RNA viruses including influenza and coronavirus. Prog Cardiovasc Dis. 2020;63(3):383–385. DOI: 10.1016/j.pcad.2020.02.007.
15. Wang B., Yee Aw. T., Stokes K.Y. N-acetylcysteine attenuates systemic platelet activation and cerebral vessel thrombosis in diabetes. Redox Biol. 2018;14:218–228. DOI: 10.1016/j.redox.2017.09.005.
16. Авдеев С.Н., Гайнитдинова В.В., Мержоева З.М. и др. N-ацетилцистеин в комплексном лечении COVID-ассоциированной пневмонии. РМЖ. 2021;3:13–18. [Avdeev S.N., Gainitdinova V.V., Merzhoeva Z.M. et al. N-acetylcysteine in the complex treatment of COVID-19 pneumonia. RMJ. 2021;3:13–18 (in Russ.)].
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