N-Acetyl Cysteine and Reduced Mortality Risk

Research synthesisModerate evidenceLarge effect4 studies · 3 beneficial · 1 neutral · 0 harmful

Across 4 studies, 3 reported beneficial effects of N-Acetyl Cysteine on reducing mortality risk, with effect sizes ranging from moderate to large. The strongest evidence comes from meta-analyses showing a 41% decreased risk of death in COVID-19 patients (RR=0.59) and significant mortality reductions in rodenticide poisoning and non-acetaminophen-induced acute liver injury. One small neutral trial found no significant mortality benefit in esophageal atresia patients, but doses, forms, and populations were inconsistent across studies.

Studied populations: COVID-19 patients, rodenticide poisoning patients, and patients with non-acetaminophen-induced acute liver injury

Caveats: Available evidence is overwhelmingly positive — clinical literature in this area is subject to publication bias (null-result studies are less likely to be published or indexed). Evidence base is small (only 4 studies) — conclusions should be considered preliminary. Study durations and doses were inconsistently reported, and the neutral trial used a nebulized form in a surgical pediatric population, which may not generalize to other populations or forms.

Generated Jun 12, 2026

Doses used in studies

Nac · mg/day: 800 (median 800, IQR 800–800) — 1 study

Safety in these studies

mechanical ventilationIncreased riskOR 3.88; CI, 1.14-13.29
the need for mechanical ventilation (OR 3.88; CI, 1.14-13.29) were significantly higher in the treatment group.
from: N-acetyl cysteine versus standard of care for non-acetaminophen induced acute liver injury
nausea and vomitingIncreased riskOR 3.99; CI, 1.42-11.19
the risk of developing nausea and vomiting (OR, 3.99; CI, 1.42-11.19) were significantly higher in the treatment group.
from: N-acetyl cysteine versus standard of care for non-acetaminophen induced acute liver injury
Overall tolerabilityReported
the majority of adverse events are transient and minor.
from: N-acetyl cysteine versus standard of care for non-acetaminophen induced acute liver injury
Overall tolerabilityReported
No specific adverse effects were observed in the study group.
from: Evaluation of nebulized N-acetyl cysteine in outcome of esophageal atresia with tracheoeso

4 of 4 papersPopulation:

COVID-19 clinical outcomes and N-acetylcysteine (CoViNAC study): a GRADE compliant meta-analysis of randomized controlled trials with molecular docking and dynamics simulation studies with Mpro of SARS-CoV-2.
- 2025-05-26
- Meta-Analysis · n = 1,125
- Cellular and molecular biology (Noisy-le-Grand, France) 71(5)
- - Seshadri Reddy Varikasuvu
  - Munikumar Manne
  - Subodh Kumar
  - Shiv Kumar Mudgal
  - Vikash Raj
  - Saurabh Varshney
  - Pratima Gupta
  - Ashoo Grover
  - Chanchal Goyal
  - Vanita Lal
  - Harminder Singh
  - Mona Lisa
  - Saransh Workshop Members
- PubMed: 40418545
- DOI: 10.14715/cmb/2025.71.5.13
2 Insights on
- Reduced Mortality Risk
- High evidence
NAC significantly reduced mortality (RR=0.59, 95% CI 0.39-0.88, p=0.01; I²=62%), indicating a 41% decreased risk of death.
Effect
Beneficial
Effect size
Large
Significant
Yes
N-Acetyl Cysteine in Rodenticide Poisoning: A Systematic Review and Meta-Analysis.
- 2022-11
- Meta-Analysis · n = 492
- Current reviews in clinical and experimental pharmacology 17(3)
- - Muhammed Rashid
  - Viji Pulikkel Chandran
  - Sreedharan Nair
  - Deepa Sudalai Muthu
  - Jemima Pappuraj
  - Krupa Ann Jacob
  - Balaji Sridhar
  - Karen Mark
  - Shabnam Hyder
  - Sohil Khan
  - Girish Thunga
- PubMed: 34455951
- DOI: 10.2174/2772432816666210825102726
4 Insights on
- Reduced Mortality Risk
- High evidence
Metaanalysis of RCTs (OR: 0.25; 95% CI: 0.11-0.59; n=2) and retrospective studies (OR: 0.34; 95% CI: 0.15-0.78; n=3) showed a significant reduction in mortality
Effect
Beneficial
Effect size
Large
Significant
Yes
N-acetyl cysteine versus standard of care for non-acetaminophen induced acute liver injury: a systematic review and meta-analysis.
- 2021-09
- Meta-Analysis · n = 11
- Annals of hepatology 24
- - Dhan Bahadur Shrestha
  - Pravash Budhathoki
  - Yub Raj Sedhai
  - Anurag Adhikari
  - Ayusha Poudel
  - Barun Aryal
  - Ramkaji Baniya
- PubMed: 33722689
- DOI: 10.1016/j.aohep.2021.100340
3 Insights on
- Reduced Mortality Risk
- High evidence
- Clinical
Use of NAC in non-acetaminophen induced ALI showed 53% reduction in mortality compared to standard of care (OR, 0.47; CI, 0.29-0.75)
Effect
Beneficial
Effect size
Moderate
Significant
Yes
Evaluation of nebulized N-acetyl cysteine in outcome of esophageal atresia with tracheoesophegeal fistula.
- 2020-12
- Clinical Trial · n = 30
- Journal of pediatric surgery 55(12)
- - Gurmeet Singh
  - Anand Pandey
  - Gaurav Shandilya
  - Archika Gupta
  - J D Rawat
  - Ashish Wakhlu
  - S N Kureel
- PubMed: 32467034
- DOI: 10.1016/j.jpedsurg.2020.04.013
3 Insights on
- Reduced Mortality Risk
- High evidence
- Clinical
There was no significant (p = 0.41) difference in mortality between the groups.
Effect
Neutral
Effect size
Small
Significant
No
Dose
2 mL of 10% NAC, nebulized (2:5 dilution, every six hourly)

N-Acetyl Cysteine and Reduced Mortality Risk

COVID-19 clinical outcomes and N-acetylcysteine (CoViNAC study): a GRADE compliant meta-analysis of randomized controlled trials with molecular docking and dynamics simulation studies with Mpro of SARS-CoV-2.

N-Acetyl Cysteine in Rodenticide Poisoning: A Systematic Review and Meta-Analysis.

N-acetyl cysteine versus standard of care for non-acetaminophen induced acute liver injury: a systematic review and meta-analysis.

Evaluation of nebulized N-acetyl cysteine in outcome of esophageal atresia with tracheoesophegeal fistula.