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Objective: To assess the effects of L-carnitine on the outcomes of patients with moderate to severe coronavirus disease 2019 (COVID-19) in intensive care unit (ICU). Methods: This double-blind clinical trial was carried out in 2022-2023. 64 Patients with COVID-19 were selected from Amiralmomenin and Khansari hospitals in Arak, Iran. They were randomly assigned to the control and the L-carnitine treatment group via block randomization. Venous blood gases, disease severity, and levels of D-dimer, lactate dehydrogenase, ferritin, and C-reactive protein were daily assessed during the seven days of the intervention, and the length of ICU stay, the need for endotracheal intubation, and mortality rate were documented. Results: There were significant differences in length of ICU stay, the need for endotracheal intubation, and levels of D-dimer, lactate dehydrogenase, ferritin, APACHE II score, and C-reactive protein between the two groups (P<0.05). However, the groups did not significantly differ in mortality rate and venous blood gas indexes (P>0.05). Conclusions: L-carnitine can improve outcomes of patients with COVID-19. Therefore, it can be used as an adjuvant therapy for these patients. Trial registration: Iranian Registry of Clinical Trials identifier IRCT20141209020258N165.