Response to Intravenous N-Acetylcysteine Supplementation in Critically Ill Patients with COVID-19

Abstract: nutrients Article Response to Intravenous N-Acetylcysteine Supplementation in Critically Ill Patients with COVID-19 Yenifer Gamarra-Morales 1, * , Lourdes Herrera-Quintana 2 , Jorge Molina-López 3, * , Héctor Vázquez-Lorente 2 , Juan Francisco Machado-Casas 4 , José Castaño-Pérez 4 , José Miguel Pérez-Villares 4 and Elena Planells 2 1 2 3 4 * Citation: Gamarra-Morales, Y.; Herrera-Quintana, L.; Molina-López, J.; Vázquez-Lorente, H.; Machado-Casas, J.F.; Castaño-Pérez, J.; Pérez-Villares, J.M.; Planells, E. Clinical Analysis Unit, Valle de los Pedroches Hospital, Pozoblanco, 14400 Córdoba, Spain Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain Intensive Care Unit, Virgen de las Nieves Hospital, Fuerzas Armadas Avenue, 18014 Granada, Spain Correspondence: jennifer_gamo@hotmail.com (Y.G.-M.); jorge.molina@ddi.uhu.es (J.M.-L.) Abstract: Administering N-acetylcysteine (NAC) could counteract the effect of free radicals, improving the clinical evolution of patients admitted to the Intensive Care Unit (ICU). This study aimed to investigate the clinical and biochemical effects of administering NAC to critically ill patients with COVID-19. A randomized controlled clinical trial was conducted on ICU patients (n = 140) with COVID-19 and divided into two groups: patients treated with NAC (NAC-treated group) and patients without NAC treatment (control group). NAC was administered as a continuous infusion with a loading dose and a maintenance dose during the study period (from admission until the third day of ICU stay). NAC-treated patients showed higher PaO2 /FiO2 (p ≤ 0.014) after 3 days in ICU than their control group counterparts. Moreover, C-reactive protein (p ≤ 0.001), D-dimer (p ≤ 0.042), and lactate dehydrogenase (p ≤ 0.001) levels decreased on the third day in NAC-treated patients. Glutathione concentrations decreased in both NAC-treated (p ≤ 0.004) and control (p ≤ 0.047) groups after 3 days in ICU; whereas glutathione peroxidase did not change during the ICU stay. The administration of NAC manages to improve the clinical and analytical response of seriously ill patients with COVID-19 compared to the control group. NAC is able to stop the decrease in glutathione concentrations. Response to Intravenous N-Acetylcysteine Supplementation in Keywords: COVID-19; N-acetylcysteine; mortality; antioxidant; pneumonia; biomarker Critically Ill Patients with COVID-19. Nutrients 2023, 15, 2235. https:// doi.org/10.3390/nu15092235 Academic Editors: George Briassoulis, Panagiotis Briassoulis and Stavroula Ilia Received: 4 April 2023 Revised: 1 May 2023 Accepted: 7 May 2023 Published: 8 May 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/