Administration of N-acetylcysteine (Nac) as Adjunctive Therapy for Covid-19 Patients by Improving Oxidative Stress and Inflammation through Assessment of Ldh, Crp, D-dimer, and Ferritin

Abstract

INTRODUCTION Lactate dehydrogenase (LDH), C-Reactive Protein (CRP), D-dimer and feritin are acute phase proteins which levels may rise in the presence of an inflammatory process of COVID-19. N-Acetylcysteine (NAC) is an antioxidant which has also been widely considered as adjunctive therapy in COVID-19. We aim to analyze the effect of NAC administration in improving oxidative stress and inflammation in COVID-19 through assessment of LDH, CRP, D-dimer, and feritin levels. METHOD A quasi-experimental study with pre-post design. LDH, CRP, D-dimer, and feritin levels were measured in admission and day 8 of administration of 5000 mg/72 hours of NAC. RESULT There is a significant decrease in CRP, LDH, D-dimer and Ferritin levels between admission and day 8 of NAC therapy. CRP levels were reduced from 185.31 ± 181.30 to 97.60 ± 161.86 (p<0.001), LDH levels were reduced from 4.65 ± 4.13 to 1.87 ± 0.96 (p<0.001), D-dimer levels were reduced from 185.31 ± 181.30 to 97.60 ± 161.86 (p<0.001) and Ferritin levels were reduced from 4.65 ± 4.13 to 1.87 ± 0.96 (p<0.001). DISCUSSION There is a significant decrease of LDH, CRP, D-dimer, and feritin levels from day-1 (admission) to day-8 of NAC administration in accordance with existing theories. This implies the ability of NAC to reduce oxidative stress and inflammation in COVID-19 patients. CONCLUSION There was a decrease in CRP, LDH, D-dimer and Ferritin after administration of NAC in COVID-19 patients and a positive correlation between severity and mortality towards acute phase protein in COVID-19 patients.