Abstract: Infectious Diseases ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/infd20 N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study Stelios F. Assimakopoulos, Diamanto Aretha, Dimitris Komninos, Dimitra Dimitropoulou, Maria Lagadinou, Lydia Leonidou, Ioanna Oikonomou, Athanasia Mouzaki & Markos Marangos To cite this article: Stelios F. Assimakopoulos, Diamanto Aretha, Dimitris Komninos, Dimitra Dimitropoulou, Maria Lagadinou, Lydia Leonidou, Ioanna Oikonomou, Athanasia Mouzaki & Markos Marangos (2021) N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study, Infectious Diseases, 53:11, 847-854, DOI: 10.1080/23744235.2021.1945675 To link to this article: https://doi.org/10.1080/23744235.2021.1945675 Published online: 29 Jun 2021. Submit your article to this journal Article views: 1815 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=infd20 INFECTIOUS DISEASES, 2021; VOL. 53, NO. 11, 847–854 https://doi.org/10.1080/23744235.2021.1945675 ORIGINAL ARTICLE N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study Stelios F. Assimakopoulosa , Diamanto Arethab, Dimitris Komninosc, Dimitra Dimitropoulouc, Maria Lagadinoua, Lydia Leonidoua, Ioanna Oikonomoua, Athanasia Mouzakid and Markos Marangosa a Department of Internal Medicine, University of Patras Medical School, Patras, Greece; bDepartment of Anesthesiology and Intensive Care Medicine, University of Patras Medical School, Patras, Greece; cDepartment of Internal Medicine, “St Andrews” State General Hospital, Patras, Greece; dDivision of Hematology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece ABSTRACT Background: N-acetyl-cysteine (NAC) has been previously shown to exert beneficial effects in diverse respiratory diseases, through antioxidant and anti-inflammatory actions. Our aim was to evaluate NAC potential impact in hospitalised patients with COVID-19 pneumonia, in terms of progression to severe respiratory failure (SRF) and mortality. Patients and Methods: This retrospective, two-centre cohort study included consecutive patients hospitalised with moderate or severe COVID-19 pneumonia. Patients who received standard of care were compared with patients who additionally received NAC 600 mg bid orally for 14 days. Patients’ clinical course was recorded regarding (i) the development of SRF (PO2/FiO2 <150) requiring mechanical ventilation support and (ii) mortality at 14 and 28 days. Results: A total of 82 patients were included, 42 in the NAC group and 40 in the control group. Treatment with oral NAC led to significantly lower rates of progression to SRF as compared to the control group (p < .01). Patients in the NAC group presented significantly lower 14- and 28-day mortality as compared to controls (p < .001 and p < .01 respectively). NAC treatment significantly reduced 14- and 28-day mortality in patients with severe disease (p < .001, respectively). NAC improved over time the PO2/FiO2 ratio and decreased the white blood cell, CRP, D-dimers and LDH levels. In the..