A RETROSPECTIVE ANALYSIS OF OUTCOMES AMONGST COVID-19 PATIENTS WITH ACUTE HEPATITIS RECEIVING N-ACETYLCYSTEINE THERAPY IN A SAFETY NET HOSPITAL

ABSTRACT

PURPOSE AND BACKGROUND: The novel coronavirus (COVID-19) threatened the existence of mankind in its debut in the year 2019. Although primarily affecting the pulmonary system, patients infected with COVID-19 displayed widespread systemic insult. A majority of patients exhibited hepatic injury throughout their course of infection. In this study we investigate the use of N-acetylcysteine (NAC) in patients hospitalized due to COVID-19 with acute hepatitis and its effect on overall outcomes. MATERIAL AND METHODS: A retrospective analysis of medical records was performed on 864 patients hospitalized with COVID-19 infection from March 13th, 2020 to May 13th, 2020 at Nassau University Medical Center in New York. The primary outcome of interest was mortality. Logistic regression analysis controlling for confounding variables was used to determine the association of NAC and mortality in patients infected with COVID-19. The review included patients with acute hepatitis demonstrated by alanine aminotransferase (ALT) and aspartate aminotransferase (AST) greater than 120 U/L (3 times the upper level of normal) during their hospitalization. Patients received NAC in the form of oral, intravenous (IV), or both. Statistical analysis was performed to assess all-cause mortality within these three groups who received NAC and to those who did not receive NAC. RESULTS: A total of 138 patients were included in this study. Among them, 114 received oral NAC, 15 received IV, and 9 received both. Multivariate logistic regression model predicting mortality and controlling for age, CAD, Intubation, HTN, and DM was performed to determine the association of NAC and mortality. This study showed a statistically significant (p-value < 0.05) decrease in all-cause mortality in patients who received oral NAC when compared to those who received IV NAC or both. Furthermore, this study also indicated that patients who did not receive any form of NAC had a statistically significant (p-value < 0.05) increased risk of all-cause mortality compared to those who received any form of NAC. CONCLUSION: This study suggests that patients with acute hepatitis who received NAC had decreased mortality when compared to patients who did not receive NAC. Oral NAC was associated with the lowest risk of all-cause mortality amongst patients who received NAC as IV or both. In addition, patients with acute hepatitis who received any form of NAC had overall decreased all-cause mortality as compared to patients who did not receive NAC. A potential limitation to this study may be the relatively small sample size and missing lab values used to determine the effectiveness of NAC, which further reduced the size of the dataset. A greater sample size would increase the power of the study and aid in assessing outcomes in patients infected with COVID-19.