Chen Chih-Hao, Hung Kai-Feng, Huang Chii-Yuan, Leong Jing-Li, Chu Yuan-Chia, Chang Chun-Yu, Wang Mong-Lien, Chiou Shih-Hwa, Cheng Yen-Fu
Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2023 Mar 1;86(3):274-281. doi: 10.1097/JCMA.0000000000000869. Epub 2023 Jan 9.
Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). It has brought tremendous challenges to public health and medical systems around the world. The current strategy for drug repurposing has accumulated some evidence on the use of N -acetylcysteine (NAC) in treating patients with COVID-19. However, the evidence remains debated.
We performed the systematic review and meta-analysis that complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases and reference lists were searched from inception to May 14, 2022. Studies evaluating the efficacy of NAC in treating patients with COVID-19 were regarded as eligible. The review was registered prospectively on PROSPERO (CRD42022332791).
Of 778 records identified from the preliminary search, four studies were enrolled in the final qualitative review and quantitative meta-analysis. A total of 355 patients were allocated into the NAC group and the control group. The evaluated outcomes included intubation rate, improvement, duration of intensive unit stay and hospital stay and mortality. The pooled results showed nonsignificant differences in intubation rate (OR, 0.55; 95% CI, 0.16-1.89; p = 0.34; I2 = 75%), improvement of oxygenation ([MD], 80.84; 95% CI, -38.16 to 199.84; p = 0.18; I2 = 98%), ICU stay (MD, -0.74; 95% CI, -3.19 to 1.71; p = 0.55; I2 = 95%), hospital stay (MD, -1.05; 95% CI, -3.02 to 0.92; p = 0.30; I2 = 90%), and mortality (OR, 0.58; 95% CI, 0.23-1.45; p = 0.24; I2 = 54%). Subsequent trial sequential analysis (TSA) showed conclusive nonsignificant results for mortality, while the TSA for the other outcomes suggested that a larger sample size is essential.
The current evidence reveals NAC is not beneficial for treating patients with COVID- 19 with regard to respiratory outcome, mortality, duration of ICU stay and hospital stay.
2019冠状病毒病（COVID-19）是由严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）引起的全球大流行疾病。它给世界各地的公共卫生和医疗系统带来了巨大挑战。目前的药物再利用策略已经积累了一些关于使用N-乙酰半胱氨酸（NAC）治疗COVID-19患者的证据。然而，这些证据仍存在争议。
我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了系统评价和Meta分析。从数据库建库至2022年5月14日，检索了五个数据库及参考文献列表。评估NAC治疗COVID-19患者疗效的研究被视为符合纳入标准。本评价在PROSPERO（CRD42022332791）上进行了前瞻性注册。
在初步检索中识别出的778条记录中，有四项研究纳入了最终的定性评价和定量Meta分析。共有355例患者被分配到NAC组和对照组。评估的结局指标包括插管率、病情改善情况、重症监护病房住院时间、住院时间和死亡率。汇总结果显示，在插管率（比值比[OR]，0.55；95%置信区间[CI]，0.16 - 1.89；p = 0.34；I² = 75%）、氧合改善情况（均差[MD]，80.84；95% CI，-38.16至199.84；p = 0.18；I² = 98%）、重症监护病房住院时间（MD，-0.74；95% CI，-3.19至1.71；p = 0.55；I² = 95%）、住院时间（MD，-1.05；95% CI，-3.02至0.92；p =
