Serum trace elements levels and clinical outcomes among Iranian COVID-19 patients

Abstract

Objectives : The relationship between immunity and trace elements levels is well known. We aimed to estimate the association of serum trace elements with severity and outcomes in the Coronavirus Disease-2019 (COVID-19) patients. Methods: In this single-centered, prospective, observational study, we enrolled 114 patients admitted to severe intensive care units (ICUs) and corresponding 112 sex and aged-matched non-ICU ward patients. Demographic data, clinical characteristics, and outcomes were all collected. We analyzed serum levels of zinc (Zn), copper (Cu), selenium (Se), and manganese (Mn) in both severity groups. Results : The serum levels of Cu, Se, and Mn in both groups were within the normal range while Zn serum levels were lower than the normal values. Based on these findings, Zn, Cu, Se, and Mn serum levels were not associated with disease severity ( P > 0.05). While we found Zn serum levels were strongly associated with patient outcomes ( P = 0.005). Our results indicated lower Mn serum levels were associated with age more than 55 years ( P = 0.006). Our results were not in favor of a causal relationship between serum trace elements levels and disease severity. Conclusion : We found Zn level as a strong indicator for patients’ outcomes that can be considered for monitoring of patients’ prognosis. Nutritional measures or supplementation can help reduce poor outcomes caused by low Zn levels in Iranian COVID-19 patients.

Free Zinc as a Predictive Marker for COVID-19 Mortality Risk

“…Regarding its role in SARS-CoV-2, zinc was found to not only improve the antiviral immune response, but also (i) prevent interaction of SARS-CoV-2 with the angiotensin-converting enzyme 2 (ACE2) on the cell membrane, (ii) affect cellular expression of ACE2, and (iii) impair viral replication (reviewed in [ 9 , 12 ]). Observational studies mostly comparing total serum zinc in mild, moderate, and/or severe COVID-19 patients provided strong indications that disease severity is associated with very low serum zinc levels [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Gustatory and Saliva Secretory Dysfunctions in COVID-19 Patients with Zinc Deficiency

“…Although a blood zinc level does not necessarily reflect the zinc status of an individual, zinc serum (or plasma) concentrations can be used as an indicator for the populational zinc status [ 133 ]. Table 1 summarizes serum zinc concentrations of COVID-19 patients reported by 15 studies [ 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 ], together with comorbidities such as diabetes mellitus, hypertension, respiratory disease, and cardiovascular disease that potentially induce zinc deficiency. Serum zinc concentrations ranged from 73 μg/dL to 106 μg/dL in controls or healthy subjects [ 135 , 136 , 141 , 145 , 146 , 148 ], whereas they ranged from 57 μg/dL to 80 μg/dL in COVID-19 patients [ 135 , 136 , 139 , 140 , 141 , 142 , 143 , 145 , 146 , 147 , 148 ].…”

“…Table 1 summarizes serum zinc concentrations of COVID-19 patients reported by 15 studies [ 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 ], together with comorbidities such as diabetes mellitus, hypertension, respiratory disease, and cardiovascular disease that potentially induce zinc deficiency. Serum zinc concentrations ranged from 73 μg/dL to 106 μg/dL in controls or healthy subjects [ 135 , 136 , 141 , 145 , 146 , 148 ], whereas they ranged from 57 μg/dL to 80 μg/dL in COVID-19 patients [ 135 , 136 , 139 , 140 , 141 , 142 , 143 , 145 , 146 , 147 , 148 ]. The ratio of serum zinc deficiency was 57.4% in Indian COVID-19 patients [ 135 ] and 95.7% in Belgium COVID-19 patients [ 146 ] when the cutoff zinc concentration was defined as <80 μg/dL.…”

“…Figure 5 A shows the quantitative results of zinc concentrations in serum obtained from COVID-19 patients and healthy subjects (or controls) in different cohorts [ 135 , 136 , 137 , 141 , 145 , 146 , 148 ]. Serum zinc concentration (mean ± SD) was 64.8 ± 7.5 μg/dL and 88.3 ± 14.0 μg/dL for COVID-19 patients and controls, respectively, indicating a significant difference between the two groups ( p < 0.01) ( Figure 5 B).…”

Selenium: An Element of Life Essential for Thyroid Function

“…Se levels are lower in patients with COVID-19 than in healthy subjects [ 99 , 100 ]. Furthermore, Se deficiency has been associated with the risk of COVID-19 complications and mortality, although the relationship between Se and COVID-19 severity is not definitively demonstrated [ 101 , 102 , 103 , 104 , 105 , 106 , 107 ]. Besides, an association between soil Se content and COVID-19 incidence was found in different cities in Hubei Province, as well as an association between soil Se content and the reported outcomes of COVID-19 cases in China [ 108 , 109 ].…”