Serum Iron Level as a Potential Predictor of Coronavirus Disease 2019 Severity and Mortality: A Retrospective Study

Zhao, Kang; Huang, Jucun; Dai, Dan; Feng, Yuwei; Liu, Li Ming; Nie, Shuke

doi:10.1093/ofid/ofaa250

Cited by 124 publications

(162 citation statements)

References 17 publications

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“…Serum iron level was reported as a potential predictor of COVID-19 severity and mortality [29]. Decreased serum iron level could predict the transition of COVID-19 from mild to severe and critical illness [30,29], which was in agreement with our ndings. Zinc is one of the micronutrients that could be consumed to reduce the intensity of SARS-CoV-2 infection and perhaps lessen the respiratory tract infection through the antiviral actions [7].…”

Section: Discussionsupporting

confidence: 91%

“…For iron, systemic dysregulation resulted from COVID-19 hyperin ammation has been recently reviewed [28]. Serum iron level was reported as a potential predictor of COVID-19 severity and mortality [29]. Decreased serum iron level could predict the transition of COVID-19 from mild to severe and critical illness [30,29], which was in agreement with our ndings.…”

Section: Discussionsupporting

confidence: 88%

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Associations of blood essential and toxic metal(loid)s with both disease severity and mortality in patients with COVID-19: a retrospective study

Zeng

Yang

Yuan

et al. 2020

Preprint

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Background The variations and dynamics of blood essential and toxic metal(loid)s in patients with COVID-19 still remains unclear.Methods A retrospective study was performed in a cohort of confirmed COVID-19 patients for their whole blood levels of essential and/or toxic metal(loid)s including magnesium, calcium, chromium, manganese, iron, copper, zinc, arsenic, cadmium, mercury, thallium and lead according to the disease severity and outcome.Results Compared to the non-severe COVID-19 patients, Whole blood calcium, chromium and copper were higher in the severe patients, while magnesium, manganese, iron, zinc, arsenic, thallium and lead were lower. These differences were further found to be consistently existed across the clinical course since the disease onset by longitudinal analysis. Moreover, among the severe patients, chromium and cadmium were higher in the deceased group compared to the recovered group, while arsenic were found to be lower. Whole blood iron, arsenic, and age and sex were determined to be independently factors associated with the disease severity, while chromium, cadmium and the co-morbidity of cardiovascular disease were determined to be independently factors associated with the mortality.Conclusions These results suggest variations of whole blood metal(loid)s as associated factors correlated with the disease severity and mortality for COVID-19.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Associations of blood essential and toxic metal(loid)s with both disease severity and mortality in patients with COVID-19: a retrospective study

Zeng

Yang

Yuan

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Therefore, optimal iron status may be crucial for better disease prognosis. So, a retrospective study based on 50 hospitalized Chinese subjects with confirmed COVID-19, demonstrated that 90% of these subjects (45) showed abnormally low serum iron concentrations (<7.8 μM) and the severity of the disease negatively correlated with serum iron concentrations [ 124 ]. For this reason, populations with lower iron status could be more prone to suffer a mild to severe (or critical) symptomatology of COVID-19 and the fact of monitoring patient iron levels has been proposed as a potential early marker to predict COVID-19 severity and mortality [ 124 ].…”

Section: Association Between 10 Critical Micronutrients and Prevalmentioning

confidence: 99%

Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework

2020

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The pandemic caused by the new coronavirus has caused shock waves in many countries, producing a global health crisis worldwide. Lack of knowledge of the biological mechanisms of viruses, plus the absence of effective treatments against the disease (COVID-19) and/or vaccines have pulled factors that can compromise the proper functioning of the immune system to fight against infectious diseases into the spotlight. The optimal status of specific nutrients is considered crucial to keeping immune components within their normal activity, helping to avoid and overcome infections. Specifically, the European Food Safety Authority (EFSA) evaluated and deems six vitamins (D, A, C, Folate, B6, B12) and four minerals (zinc, iron, copper and selenium) to be essential for the normal functioning of the immune system, due to the scientific evidence collected so far. In this report, an update on the evidence of the contribution of nutritional factors as immune-enhancing aspects, factors that could reduce their bioavailability, and the role of the optimal status of these nutrients within the COVID-19 pandemic context was carried out. First, a non-systematic review of the current state of knowledge regarding the impact of an optimal nutritional status of these nutrients on the proper functioning of the immune system as well as their potential role in COVID-19 prevention/treatment was carried out by searching for available scientific evidence in PubMed and LitCovid databases. Second, a compilation from published sources and an analysis of nutritional data from 10 European countries was performed, and the relationship between country nutritional status and epidemiological COVID-19 data (available in the Worldometers database) was evaluated following an ecological study design. Furthermore, the potential effect of genetics was considered through the selection of genetic variants previously identified in Genome-Wide Association studies (GWAs) as influencing the nutritional status of these 10 considered nutrients. Therefore, access to genetic information in accessible databases (1000genomes, by Ensembl) of individuals from European populations enabled an approximation that countries might present a greater risk of suboptimal status of the nutrients studied. Results from the review approach show the importance of maintaining a correct nutritional status of these 10 nutrients analyzed for the health of the immune system, highlighting the importance of Vitamin D and iron in the context of COVID-19. Besides, the ecological study demonstrates that intake levels of relevant micronutrients—especially Vitamins D, C, B12, and iron—are inversely associated with higher COVID-19 incidence and/or mortality, particularly in populations genetically predisposed to show lower micronutrient status. In conclusion, nutrigenetic data provided by joint assessment of 10 essential nutrients for the functioning of the immune system and of the genetic factors that can limit their bioavailability can be a fundamental tool to help strengthen the immune system of individuals and prepare populations to fight against infectious diseases such as COVID-19.

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“…Iron metabolism disturbance has been widely reported in various infectious diseases. S. Typhi competes with humans for iron utilization by increasing the expression of hepcidin, which can restrict iron uptake and macrophage iron release, and the high serum hepcidin leads to hypoferremia [8]; COVID-19 infection resulted in hyperferritinemia due to cytokine storms, and serum iron transferrin saturation in intensive care unit (ICU) patients infected with COVID-19 was extremely reduced for the rst 2 days and then increased from days 3 to 6 [9,27,28]. In this study, we found that serum iron was signi cantly decreased in S. Enteritidis patients, and it seemed to be lower in patients with more serious symptoms; with the recovery of patients' symptoms, serum iron increased.…”

Section: Discussionmentioning

confidence: 99%

Serum iron, prealbumin, D-dimer and prothrombin time are indicators of the diagnosis, severity and outcome of Salmonella enterica serovar Enteritidis infection

Wang

Liu

et al. 2020

Preprint

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Aims Salmonella enterica serovar Enteritidis (S. Enteritidis) infection is one of the main causes of foodborne illness among individuals in the military. In this study, we aimed to investigate indicators associated with the diagnosis, severity and outcome of S. Enteritidis infection, and to analyze the antimicrobial susceptibility of the isolated S. Enteritidis strains.Methods Routine stool test, fecal occult blood tests (FOBTs), routine blood tests and blood biochemical analyses were completed in our clinical laboratory. The stool samples were inoculated on Salmonella Shigella (SS) agar plates, the single bacterial colony was identified with mass spectrometry (MS). The serum agglutination test was performed to identify the Salmonella serotype. Antimicrobial susceptibility testing was performed using the minimal inhibitory concentration (MIC) method with the VITEK 2 COMPACT analyzer.Results Recently, 6 patients from one company visited our department complaining of fever, watery stool, abdominal pain and so on. The patients’ white blood cell (WBC) counts (66.7%), neutrophil percentages (100%), C-reactive protein (CRP) levels (100%), prothrombin times (PTs, 100%) and serum D-dimer concentrations (83.3%) were higher or longer than normal, while serum iron (100%) and prealbumin (83.3%) were lower than normal when they were admitted. Stool cultures and serovar identification results indicated S. Enteritidis infection. The antimicrobial susceptibility results showed that the 6 isolated bacterial strains were sensitive to trimethoprim-sulfamethoxazole and levofloxacin, and resistant to ampicillin. All patients were administered levofloxacin accompanied by rifaximin and probiotics, and their symptoms and the abovementioned parameters were recovered. During the disease course, the prolonged PT, elevated D-dimer and decreased serum iron were positively correlated with severe symptoms and serum inflammatory indexes.Conclusion Prolonged PT, elevated D-dimer and hypoferremia were associated with the diagnosis, severity and outcome of S. Enteritidis infection, and a decreased prealbumin level was associated with the diagnosis of S. Enteritidis infection. In patients complaining of acute fever, watery stool and abdominal pain, PT, D-dimer，prealbumin and serum iron should be monitored to attain an early diagnosis and initiate appropriate treatment for S. Enteritidis infection.

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Serum Iron Level as a Potential Predictor of Coronavirus Disease 2019 Severity and Mortality: A Retrospective Study

Abstract: Abstract Background Various types of pulmonary diseases are associated with iron deficiency. However, information on iron status in coronavirus disease 2019 (COVID-19) is scarce. Methods This study included 50 hospitalized patients with confirmed COVID-19. The rol… Show more

Cited by 124 publications

References 17 publications

Associations of blood essential and toxic metal(loid)s with both disease severity and mortality in patients with COVID-19: a retrospective study

Associations of blood essential and toxic metal(loid)s with both disease severity and mortality in patients with COVID-19: a retrospective study

Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework

Serum iron, prealbumin, D-dimer and prothrombin time are indicators of the diagnosis, severity and outcome of Salmonella enterica serovar Enteritidis infection

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