The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In COVID-19 Patients
Ramadhan et al., Indonesian Journal of Tropical and Infectious Disease, 9:3
Ramadhan et al., The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α Level And Increase SPO2/FIO2 Ratio In.., Indonesian Journal of Tropical and Infectious Disease, 9:3
Prospective study with 75 NAC patients and 16 control patients, showing no significant difference in mortality.
This study is excluded in the after exclusion results of meta
analysis:
excessive unadjusted differences between groups.
Abstract: Available online at IJTID Website: https://e-journal.unair.ac.id/IJTID/
Vol. 9 No. 3 September–December 2021
The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α
Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In
COVID-19 Patients
1
1
1
1
Fitratul Ramadhan , Ngakan Putu Parsama Putra , Ungky Agus Setyawan , Susanthy Djajalaksana , Aditya Sri
1
2
Listyoko , Harun al Rasyid
1
Department of Pulmonology and Medical Respiration, Faculty of Medicine, Universitas Brawijaya-RSUD Dr Saiful Anwar,
Malang Indonesia
2
Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Brawijaya, Malang Indonesia
Received: 22 stOctober 2021; Revised: 28 th November 2021; Accepted: 23 thDecember 2021
ABSTRACT
Tumor Necrosis Factor Alpha (TNF-α) is a pro-inflammatory cytokine that plays a crucial role in COVID-19 disease
progression. N-acetylcysteine (NAC) works throughout several GSH-mediated mechanisms and is known to eliminate
oxidative stress in acute respiratory distress syndrome (ARDS) in COVID-19. This study aims to analyze the e ect of
the N-Acetylcysteine as Adjuvant Therapy to reduce TNF-α levels and Increase SpO2/FiO2 ratio in Improving
hypoxemia in COVID-19 Patients. This is a quasi-experimental, non-equivalent control group design study. There
were 91 subjects selected using non-random sampling, which consisted of 75 patients in the NAC group and 16
patients in the control group. The TNF-α level was measured using the ELISA method, and SpO2/FiO2 ratio was
calculated on day 1 (on admission) and day eight after NAC 5000mg/ 72 hours was given. Statistical analysis was
conducted using Wilcoxon and Mann-Whitney U Test. There is a significant decrease in TNF-α level in the treatment
group (median 1.49±5.22) (p=0.016) compared with the control group (median 1.64±1.99) (p=0.005). The Median
SpO2/FiO2 ratio on day 1 is 163.70±69.64 in the control group and 121.49±40.41 in the treatment group (p=0.005).
The Median SpO2/FiO2 ratio on day 8 is 249.69±132.26 in the control group and 151.29±59.18 in the treatment group
(p=0.001). There is a positive correlation between serum TNF-α level and SpO2/FiO2 ratio after administration of
adjuvant therapy NAC (r=0.240, p=0.038). There is a positive correlation and significant decrease of serum TNF-α
and SpO2/FiO2 ratio after adjuvant NAC therapy, which improves hypoxemia in COVID-19 patients.
Keywords: N-acetylcysteine, TNF-α, SpO2/FiO2 ratio
ABSTRAK
Tumor Necrosis Factor Alpha (TNF-α) merupakan sitokin proinflamasi yang berperan penting dalam perkembangan
penyakit COVID-19. N-acetylcysteine (NAC) bekerja melalui beberapa mekanisme yang dimediasi GSH dan diketahui
menghilangkan stres oksidatif pada acute respiratory distress syndrome (ARDS) pada COVID-19. Penelitian ini
bertujuan untuk menganalisis pengaruh NAC sebagai terapi Adjuvant untuk menurunkan kadar TNF-α dan
Meningkatkan rasio SpO2/FiO2 dalam Memperbaiki Hipoksemia pada Pasien COVID-19. Penelitian ini merupakan
quasi-experimental, non-equivalent control group designed study. Subyek yang dipilih sebanyak 91 orang dengan non
random sampling, yang terdiri dari 75 pasien pada kelompok NAC dan 16 pasien pada kelompok kontrol. Kadar TNFα diukur menggunakan metode ELISA dan Rasio SpO2/FiO2 diukur pada hari ke-1 (saat masuk) dan hari ke-8 setelah
pemberian NAC 5000mg/72 jam. Analisis statistik dilakukan dengan menggunakan Wilcoxon dan Mann-Whitney U
Test. Terdapat penurunan kadar TNF-α yang signifikan pada..
Late treatment is less effective
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