Kritik COVID-19 hastalarında kullanılan N-asetilsisteinin(NAC) klinik bulgulara, inflamatuar parametrelere böbrek fonksiyonlarına olan etkileri

Yıl 2022, Cilt: 3 Sayı: 2, 1 - 5, 25.10.2022

Mine Altınkaya Çavuş , Hilal Sipahioğlu

Öz

Amaç: Bu çalışmada N-asetilsistein (NAC)’in COVID-19 nedeniyle üçüncü basamak yoğun bakım ihtiyacı olan kritik hastalarda; klinik bulgulara, inflamatuar parametrelere, böbrek fonksiyonlarına olan etkileri araştırıldı.
Materyal ve Metod: Bu tek merkezli retrospektif çalışmaya, Nisan- Eylül 2020 tarihleri arasında COVİD-19 PCR pozitifliği doğrulanmış 190 yetişkin hasta dahil edildi. Standart tedaviye ek olarak NAC (2400mg/gün dozda intravenöz olarak günde 1 defa) alan hastalar ile tek başına standart tedavi verilen hastaların klinik ve laboratuar bulguları karşılaştırıldı.
Bulgular: Gruplar arasında yaş (p=0.423), cinsiyet (p=0.086), entübasyon (p=0,196), ölüm (p=0,387), hastane yatış (p=0,085) ve yoğun bakım yatış gün sayısı (p=0.584) açısından fark saptanmadı. Birinci gün, üçüncü gün, yedinci gün, onuncu gün ve onbeşinci gün bakılan CRP (C-reactive protein), ferritin, fibrinojen, nötrofil, lenfosit sayısı, D-dimer, kreatinin değerlerinde NAC alan ve almayanlar arasında anlamlı bir fark saptanmadı (p>0.05).
Sonuç: COVID-19 nedeniyle 3. Basamak yoğun bakım yatışı olan hastalarda NAC tedavisi ölümü, hastane yatış ve yoğun bakım yatış gün sayısını etkilememiştir. Aynı zamanda inflamatuar parametrelere böbrek fonksiyonlarına olumlu veya olumsuz bir etki göstermemiştir.

Anahtar Kelimeler

COVID-19, N-asetilsistein, yoğun bakım

The effects of N-acetylcysteine (NAC) used in critical COVID-19 patients on clinical findings, inflammatory parameters and kidney functions

Öz

Objective: In this study, N-acetylcysteine (NAC) was used in critically ill patients who needed tertiary care due to COVID-19; The effects on clinical findings, inflammatory parameters and kidney functions were investigated.
Materials and Methods: 190 adult patients with confirmed COVID-19 PCR positivity between April and September 2020 were included in this single-center retrospective study. The clinical and laboratory findings of the patients who received NAC (2400mg/day intravenously once a day) in addition to the standard treatment and the patients who were given the standard treatment alone were compared.
Results: Age (p=0.423), gender (p=0.086), intubation (p=0.196), death (p=0.387), hospitalization (p=0.085), and intensive care unit stay (p=0.584) between groups There was no difference in terms of No significant difference was found between those who took NAC and those who did not, in the values of CRP (C-reactive protein), ferritin, fibrinogen, neutrophil, lymphocyte count, D-dimer, and creatinine measured on the first day, third day, seventh day, tenth day and fifteenth day (p> 0.05).
Conclusion: NAC treatment did not affect the number of deaths, hospitalization and intensive care hospitalization days in patients admitted to the 3rd line intensive care unit due to COVID-19. At the same time, it did not show a positive or negative effect on inflammatory parameters and kidney functions.

Anahtar Kelimeler

COVID-19, N-acetylcysteine, intensive care

Kaynakça

• 1 T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Bilim kurulu çalışması, covıd-19 (sars-cOV-2 enfeksiyonu) rehberi. https://www.fip.org/files/content/priority-areas/coronavirus/mo-resources/Turkey_SARSCoV2InfectionGuide.pdf). Erişim tarihi 14 Nisan 2020.
• 2 Šalamon Š, Kramar B, Marolt TP, Poljšak B, Milisav I. Medical and Dietary Uses of N-Acetylcysteine. Antioxidants (Basel). 2019;8(5):111.
• 3 Aldini G, Altomare A, Baron G, Vistoli G, Carini M, Borsani L, Sergio F. N-Acetylcysteine as an antioxidant and disulphide breaking agent: the reasons why. Free Radic Res. 2018; 52: 751-762.
• 4 Ershad M, Naji A, Vearrier D. N Asetilsistein. [2020 Haz 28'de güncellendi]. İçinde: StatPearls [İnternet]. Treasure Island (FL): StatPearls Publishing; 2021 Ocak-. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK537183/
• 5 Roederer M, Ela SW, Staal FJ, Herzenberg LA. N-acetylcysteine: a new approach to anti-HIV therapy. AIDS Res Hum Retroviruses.1992; 8: 209-217.
• 6 Liu Y, Yao W, Xu J, Qiu Y, Cao F, Li S, ve ark. The anti-inflammatory effects of acetaminophen and N-acetylcysteine through suppression of the NLRP3 inflammasome pathway in LPS-challenged piglet mononuclear phagocytes. Innate Immun. 2015;21:587-597.
• 7 Ibrahim H, Perl A, Smith D, Lewis T, Kon Z, Goldenberg R, Yarta K, Staniloae C, Williams M. Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous Nacetylcysteine. Clin Immunol. 2020;219:108544.
• 8 Tarık Alhawassi. Inflammatory Regulation Effect of NAC on COVID-19 Treatment (INFECT- 19), 2020 [10 Mayıs 2021'de alıntılanmıştır]. Amerika Birleşik Devletleri Ulusal Tıp Kütüphanesi. Dan Uygun: https://clinicaltrials.gov/ct2/show/ NCT04455243.
• 9. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. Erişim adresi: https://www.who.int/docs/default-source/coronaviruse/clinicalmanagement-of-novel-cov. Erişim tarihi: 10 Mayıs 2021.
• 10 Dominari A, Hathaway III D, Kapasi A, Paul T, Makkar SS, Castaneda V, ve ark. Bottom-up analysis of emergent properties of N-acetylcysteine as an adjuvant therapy for COVID-19. World J Virol. 2021 March 25; 10(2): 34-52.
• 11 M. Porcu, M.R. Urbano, W.A. Verri, D.S. Barbosa, M. Baracat, H.O. Vargas, ve ark. Effects of adjunctive N-acetylcysteine on depressive symptoms: modulation by baseline high-sensitivity C-reactive protein, Psychiatry Res. 2018; 263: 268-274.
• 12 R. Zuin, A. Palamidese, R. Negrin, L. Catozzo, A. Scarda, M. Balbinot, High-dose NFig acetylcysteine in patients with exacerbations of chronic obstructive pulmonary disease, Clin. Drug Invest. 2005;25(6):401-8.
• 13 Hou W, Zhang W, Jin R, Liang L, Xu B, Hu Z. Risk factors for disease progression in hospitalized patients with COVID-19: a retrospective cohort study, Infect Dis (Lond). 2020; 52 (7): 498-505.
• 14 Zhang J, Yu M, Tong S, Liu LY, Tang LV. Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China. J. Clin. Virol. 2020;127:104392.
• 15 Tavakolpour S, Rakhshandehroo T, Wei EX, Rashidian M. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunol Lett. 2020;225:31-32.
• 16. Chiba T, Takahashi S, Sato N, vd. Fas aracılı apoptoz, insan T hücrelerinde hücre içi glutatyon tarafından modüle edilir. Eur J Immunol . 1996; 26 ( 5 ):1164-1169.
• 17. Lai ZW, Hanczko R, Bonilla E, Caza TN, Clair B, Bartos A, ve ark. N-acetylcysteine reduces disease activity by blocking mammalian target of rapamycin in T cells from systemic lupus erythematosus patients: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2012;64 (9):2937-2946.
• 18 Aktoz M, Altay H, Aslanger E, Atalar E, Atar İ, Aytekin V, ve ark. Türk Kardiyoloji Derneği Uzlaşı Raporu: COVID-19 Pandemisi ve Kardiyovasküler Hastalıklar Konusunda Bilinmesi Gerekenler. Turk Kardiyol Dern Ars.2020;48(1):1-87.
• 19. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir. Med. 2020; 8 (4):21.
• 20. Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M. COVID-19 infection in kidney transplant recipients. Kidney Int. 2020; 97(6):1076-1082.
• 21. Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, ve ark. Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. Am J Kidney Dis. 2021;77(2):204-215.