Association of COVID-19 mortality with serum selenium, zinc and copper: Six observational studies across Europe

Abstract

IntroductionCertain trace elements are essential for life and affect immune system function, and their intake varies by region and population. Alterations in serum Se, Zn and Cu have been associated with COVID-19 mortality risk. We tested the hypothesis that a disease-specific decline occurs and correlates with mortality risk in different countries in Europe.MethodsSerum samples from 551 COVID-19 patients (including 87 non-survivors) who had participated in observational studies in Europe (Belgium, France, Germany, Ireland, Italy, and Poland) were analyzed for trace elements by total reflection X-ray fluorescence. A subset (n=2069) of the European EPIC study served as reference. Analyses were performed blinded to clinical data in one analytical laboratory.ResultsMedian levels of Se and Zn were lower than in EPIC, except for Zn in Italy. Non-survivors consistently had lower Se and Zn concentrations than survivors and displayed an elevated Cu/Zn ratio. Restricted cubic spline regression models revealed an inverse nonlinear association between Se or Zn and death, and a positive association between Cu/Zn ratio and death. With respect to patient age and sex, Se showed the highest predictive value for death (AUC=0.816), compared with Zn (0.782) or Cu (0.769).DiscussionThe data support the potential relevance of a decrease in serum Se and Zn for survival in COVID-19 across Europe. The observational study design cannot account for residual confounding and reverse causation, but supports the need for intervention trials in COVID-19 patients with severe Se and Zn deficiency to test the potential benefit of correcting their deficits for survival and convalescence.

COVID-19 in Adult Patients with Hematological Malignancies—Lessons Learned after Three Years of Pandemic

“…Unfortunately, the study did not report data for HM patients describing the typical hematological side effects of this trace element. A similar effect to low zinc level was observed for low selenium (Se) concentration in six observational studies across Europe, where non-survivors consistently had lower Se and Zn concentrations than survivors and displayed an elevated Cu/Zn ratio [ 158 ].…”

COVID-19 Severity Is Associated with Selenium Intake among Young Adults with Low Selenium and Zinc Intake in North Carolina

“…There is evidence to support a higher COVID-19 cure and lower mortality rate among selenium-deficient versus selenium-adequate individuals when supplemented with Se ( 30 , 49 , 50 ). As such, while Se-adequate individuals may not benefit from additional selenium intake, mainly due to the narrow range from beneficial to adverse outcomes, findings from this study support a potential benefit from improved selenium intake among individuals consuming a low-selenium diet, to mitigate COVID-19 severity.…”

Identifying a target group for selenium supplementation in high-risk cardiac surgery: a secondary analysis of the SUSTAIN CSX trial

“…Patient samples were analyzed at the Institute for Experimental Endocrinology (Charité Berlin, Germany) as recently described [ 18 – 20 ]. Total reflection X-ray fluorescence spectroscopy (S4 T-STAR, Bruker Nano GmbH, Berlin, Germany) was used to determine selenium concentrations.…”