Low zinc levels at clinical admission associates with poor outcomes in COVID-19

Vogel-González, Marina; Talló-Parra, Marc; Herrera-Fernández, Víctor; Pérez‐Vilaró, Gemma; Chillón, Miguel; Nogués, Xavier; Gómez-Zorrilla, Sílvia; López-Montesinos, Inmaculada; Villar, J. Pablo Sáez; Sorli-Redó, Maria Luisa; Horcajada, Juan Pablo; García-Giralt, Natàlia; Pascual, Julio; Díez, Juana; Vicente, Rubén; Güerri‐Fernández, Robert

doi:10.1101/2020.10.07.20208645

Cited by 11 publications

(9 citation statements)

References 26 publications

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“…When zinc level <80 μg/dL was defined as deficiency, 57.4% of patients were deficient in zinc, and they had higher rates of complications, prolonged hospitalization, and increased mortality. Vogel-González et al [ 166 ] also measured serum zinc of COVID-19 patients admitted to the hospital. Serum zinc levels lower than 50 μg/dL at admission correlated to worse clinical presentation, longer time to reach stability, and higher mortality.…”

Section: Possible Mechanisms Of Gustatory Dysfunctionmentioning

confidence: 99%

“…They also found the expression in human salivary glands of metabotropic zinc receptor/G-protein-coupled receptor (ZnR/GPR39) that modulates saliva secretion from submandibular glands. Since many COVID-19 patients show lower serum zinc concentrations [ 165 , 166 ], zinc deficiency may contribute to xerostomia associated with COVID-19.…”

Section: Possible Mechanisms Of Xerostomiamentioning

confidence: 99%

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Oral Symptoms Associated with COVID-19 and Their Pathogenic Mechanisms: A Literature Review

Tsuchiya

2021

Dentistry Journal

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Since the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, management of coronavirus disease 2019 (COVID-19) has been challenging for healthcare providers. The oral cavity is referred to as a target of SARS-CoV-2. The aim of this study was to review oral symptoms specific to COVID-19 patients from the point of view of symptom prevalence and pathogenesis and to speculate the pathogenic mechanisms underlying them. Scientific articles were retrieved by searching PubMed/MEDLINE, Google Scholar, medRxiv, and bioRxiv from 3 February 2020 to 31 December 2020, and they were reviewed by title, abstract, and text for relevance. The literature search indicated that COVID-19 patients frequently present with gustatory dysfunction, xerostomia, and oral mucosal lesions, while their prevalence is likely to vary by country, age, gender, and disease severity. Gustatory dysfunction and xerostomia appear at an early stage of SARS-CoV-2 infection and last relatively long. One of possible pathogenic mechanisms of both symptoms is attributed to the expression of viral cellular entry-relevant receptors in taste cells and salivary glands. Dental professionals who can first become aware of oral symptoms associated with COVID-19 will play a more active role in and make a greater contribution to diagnosis and prevention of COVID-19.

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Section: Possible Mechanisms Of Gustatory Dysfunctionmentioning

confidence: 99%

Section: Possible Mechanisms Of Xerostomiamentioning

confidence: 99%

Oral Symptoms Associated with COVID-19 and Their Pathogenic Mechanisms: A Literature Review

Tsuchiya

2021

Dentistry Journal

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“… Calder, 2020 Calder et al, 2020 Celik et al, 2021 Chaturvedi et al, 2004 Culbertson and Culotta, 2021 de Almeida Brasiel, 2020 de Jesus and de Araú jo Andrade, 2020 Ersö z and Y ı lmaz, 2021 Grzywa-Celiń ska et al, 2020 Hultman and Pollard, 2015 Moghaddam et al, 2020 Muhammad et al, 2021 Rahman and Idid, 2021 Skalny et al, 2020 Vogel-Gonzá lez et al, 2021 Zeng et al, 2021 .…”

Section: Uncited Referencementioning

confidence: 99%

The effects of some essential and toxic metals/metalloids in COVID-19: A review

Domingo

Marquès

2021

Food and Chemical Toxicology

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Thousands of studies have been conducted in order to understand in depth the characteristics of the novel coronavirus SARS-CoV-2, its infectivity and ways of transmission, and very especially everything related to the clinical and severity of the COVID-19, as well as the potential treatments. In this sense, the role that essential and toxic metals/metalloids have in the development and course of this disease is being studied. Metals/metalloids such as arsenic, cadmium, lead, mercury or vanadium, are elements with known toxic effects in mammals, while trace elements such as cobalt, copper, iron, manganese, selenium and zinc are considered essential. Given the importance of metals/metalloids in nutrition and human health, the present review was aimed at assessing the relationship between various essential and toxic metals/metalloids and the health outcomes related with the COVID-19. We are in the position to conclude that particular attention must be paid to the load/levels of essential trace elements in COVID-19 patients, mainly zinc and selenium. On the other hand, the exposure to air pollutants in general, and toxic metal/metalloids in particular, should be avoided as much as possible to reduce the possibilities of viral infections, including SARS-CoV-2.

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“…5 31 32 In summary, zinc has direct antiviral properties against SARS-CoV-2 and other coronaviruses. 31-33 There is the potential for broader multisystem effects via modulation of angiotensin converting enzyme 2 activity, inflammation, immunity, haemostasis and hypoxic responses. 5 31 32 34 Further, the risk factors for severe illness from SARS-CoV-2 infection, such as increasing age, obesity and chronic disease, are also risk factors for zinc deficiency.…”

Section: Introductionmentioning

confidence: 99%

“…5 32 35 Observational studies conducted in Germany, Spain, Japan and Iran have reported that lower baseline zinc levels in hospitalised adults were associated with a higher risk of mortality, severe illness, complications, and longer hospital stay following SARS-CoV-2 infection. 33 36-38…”

Section: Introductionmentioning

confidence: 99%

Benefits and risks of zinc for adults during covid-19: rapid systematic review and meta-analysis of randomised controlled trials

Hunter

Arentz

Goldenberg

et al. 2020

Preprint

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OBJECTIVE: To evaluate the benefits and risks of any type of zinc intervention to prevent or treat SARS-CoV-2. DESIGN: A living, systematic review and meta-analysis, incorporating rapid review methods. DATA SOURCES: 17 English and Chinese databases and clinical trial registries were searched in April/May 2020, with additional covid-19 focused searches in June and August 2020. Eligibility criteria and analysis: Randomized control trials (RCTs) published in any language comparing zinc to a control to prevent or treat SARS-CoV-2. Other viral respiratory tract infections (RTIs) were included, but the certainty of evidence downgraded twice for indirectness. Screening, data extraction, risk of bias appraisal (RoB-2 tool) and verification was performed by calibrated, single reviewers. RCTs with adult populations were prioritised for analysis. RESULTS: 123 RCTs were identified. None were specific to SARS-CoV-2 nor other coronaviruses. 28 RCTs evaluated oral (15-45mg daily), sublingual (45-300mg daily), or topical nasal (0.09-2.6 mg daily) zinc to prevent or treat nonspecific viral RTIs in 3,597 adults without zinc deficiency. Compared to placebo, zinc prevented 5 mild to moderate RTIs per 100 person-months, including in older adults (95% confidence interval 1 to 9) (number needed to treat (NTT)=20). There was no significant difference in the rates of non-serious adverse events (AE). For RTI treatment, a clinically important reduction in peak symptom severity scores was found for zinc compared to placebo (mean difference 1.2 points, 0.7 to 1.7), but not average daily symptom severity (standardised mean difference 0.2, 0.1 to 0.4). 19 fewer per 100 adults were at risk of remaining symptomatic over the first 7 days (2 to 38, NNT=5) and the mean duration of symptoms was 2 days shorter (0.2 to 3.5), however, there was substantial heterogeneity (I2 = 82% and 97%). 14 more per 100 experienced a non-serious AE (4 to 16, NNT=7) such as nausea, or mouth or nasal irritation. No differences in illness duration nor AE were found when zinc was compared to active controls. No serious AE, including copper deficiency, were reported by any RCT. Quality of life outcomes were not assessed. Confidence in these findings for SARS-CoV-2 is very low due to serious indirectness and some concerns about bias for most outcomes. CONCLUSIONS: Zinc is a potential therapeutic candidate for preventing and treating SARS-CoV-2, including older adults and adults without zinc deficiency (very low certainty). Zinc may also help to prevent other viral RTIs during the pandemic (moderate certainty) and reduce the severity and duration of symptoms (very low certainty). The pending results from seven RCTs evaluating zinc for SARS-CoV-2 will be tracked. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020182044

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Low zinc levels at clinical admission associates with poor outcomes in COVID-19

Cited by 11 publications

References 26 publications

Oral Symptoms Associated with COVID-19 and Their Pathogenic Mechanisms: A Literature Review

Oral Symptoms Associated with COVID-19 and Their Pathogenic Mechanisms: A Literature Review

The effects of some essential and toxic metals/metalloids in COVID-19: A review

Benefits and risks of zinc for adults during covid-19: rapid systematic review and meta-analysis of randomised controlled trials

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