CLINICAL AND LABORATORY OUTCOMES OF COMBINED L-ARGININE AND N-ACETYLCYSTEINE THERAPY FOR COMMUNITY-ACQUIRED PNEUMONIA IN PATIENTS WITH A HISTORY OF ISCHEMIC STROKE

Background: Community-acquired pneumonia (CAP) may be clinically more severe in patients with previous ischemic stroke because neurological impairment, dysphagia, inflammation, and vascular dysfunction can interact to worsen respiratory recovery. Objective: This study evaluated clinical and laboratory outcomes associated with adjunctive L-arginine and N-acetylcysteine (NAC) in patients with CAP and a history of ischemic stroke. Methods: The study included 150 patients with CAP. Patients with previous ischemic stroke received standard therapy alone or standard therapy supplemented with L-arginine, NAC, or both agents. Outcomes included C-reactive protein (CRP), procalcitonin (PCT), vascular endothelial growth factor (VEGF), nitric oxide (NO), endothelin-1 (ET-1), National Institutes of Health Stroke Scale (NIHSS), CURB-65, and hospitalization duration. Results: At baseline, the post-stroke CAP group had higher CRP, PCT, VEGF, and ET-1 and lower NO than the non-stroke comparison group. The combined-treatment subgroup showed the largest reported changes: CRP decreased 79.5%, PCT 80.7%, VEGF 42.5%, and ET-1 46.0%, while NO increased 59.2%. Post-treatment NIHSS and CURB-65 scores were 5.8 and 1.0, and mean hospitalization was 10.4 days. Conclusion: Combined L-arginine and NAC was associated with the most favorable biomarker and clinical profile, warranting prospective controlled confirmation before causal efficacy is inferred.

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