Prediction of survival odds in COVID-19 by zinc, age and selenoprotein P as composite biomarker

Abstract

SARS-CoV-2 infections cause the current coronavirus disease (COVID-19) pandemic and challenge the immune system with ongoing inflammation. Several redox-relevant micronutrients are known to contribute to an adequate immune response, including the essential trace elements zinc (Zn) and selenium (Se). In this study, we tested the hypothesis that COVID-19 patients are characterised by Zn deficiency and that Zn status provides prognostic information. Serum Zn was determined in serum samples (n = 171) collected consecutively from patients surviving COVID-19 (n=29) or non-survivors (n=6). Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study were used for comparison. Zn concentrations in patient samples were low as compared to healthy subjects (mean±SD; 717.4±246.2 vs 975.7±294.0 μg/L, P <0.0001). The majority of serum samples collected at different time points from the non-survivors (25/34, i.e., 73.5%) and almost half of the samples collected from the survivors (56/137, i.e., 40.9%) were below the threshold for Zn deficiency, i.e., below 638.7 μg/L (the 2.5 th percentile in the EPIC cohort). In view that the Se status biomarker and Se transporter selenoprotein P (SELENOP) is also particularly low in COVID-19, we tested the prevalence of a combined deficit, i.e., serum Zn below 638.7 μg/L and serum SELENOP below 2.56 mg/L. This combined deficit was observed in 0.15% of samples in the EPIC cohort of healthy subjects, in 19.7% of the samples collected from the surviving COVID-19 patients and in 50.0% of samples from the non-survivors. Accordingly, the composite biomarker (SELENOP and Zn with age) proved as a reliable indicator of survival in COVID-19 by receiver operating characteristic (ROC) curve analysis, yielding an area under the curve (AUC) of 94.42%. We conclude that Zn and SELENOP status within the reference ranges indicate high survival odds in COVID-19, and assume that correcting a diagnostically proven deficit in Se and/or Zn by a personalised supplementation may support convalescence.

Serum Selenium Status as a Diagnostic Marker for the Prognosis of Liver Transplantation

“…SELENOP concentrations were also significantly lower than the reference group, and mean SELENOP concentrations in LT samples (1.9 ± 0.7 mg/L) were even below the 1st percentile of the EPIC cohort (2.3 mg/L) ( Figure 3 B). The vast majority of samples displayed a profound deficit in either Se or SELENOP (93.7%), and most of these samples displayed a combined deficit (81.6%) with respect to the thresholds for Se deficiency at 70 µg/L and SELENOP at 2.56 mg/L [ 43 ] ( Figure 3 C).…”

The Implications of Zinc Therapy in Combating the COVID-19 Global Pandemic

“…This pattern was evident on viral infections through several modulation pathways such as fusion, replication, viral protein translation, viral particle entry, especially those involving respiratory system pathology. 105,118,121,123,124 A possible clarification for the relevance of zinc in the treatment of COVID-19 conditions has been attributed to its immunomodulatory effect, antiviral property, as well as its ability to regulate the inflammatory response. 112,125,126 The possible mechanisms by which zinc might be effective in the therapy of COVID-19 are based on the previous evidence with other common viral infections and limited experience with COVID-19 [ Figure 2].…”

COVID-19 pandemic: Can zinc supplementation provide an additional shield against the infection?

“…In a similar line of study, serum zinc level was found to be relatively low in samples collected from COVID-19 patients compared to the healthy counterparts. The average serum zinc level was remarkably low in the samples collected from the non-surviving COVID-19 patients (n=6) as compared to the surviving COVID-19 patients (n=29) [94] . In another uncontrolled case series study with COVID-19 patients, a high dose of oral zinc salt resulted in clinical recovery, improved oxygenation, and less shortness of breath among those patients [95] .…”