Plasma zinc status and hyperinflammatory syndrome in hospitalized COVID-19 patients: An observational study

Abstract

Zinc deficiency is associated with impaired antiviral response, cytokine releasing syndrome (CRS), and acute respiratory distress syndrome. Notably, similar complications are being observed during severe SARS-CoV-2 infection. We conducted a prospective, single-center, observational study in a tertiary university hospital (CUB-Hôpital Erasme, Brussels) to address the zinc status, the association between the plasma zinc concentration, development of CRS, and the clinical outcomes in PCR-confirmed and hospitalized COVID-19 patients. One hundred and thirty-nine eligible patients were included between May 2020 and November 2020 (median age of 65 years [IQR = 54, 77]). Our cohort's median plasma zinc concentration was 57 µg/dL (interquartile range [IQR] = 45, 67) compared to 74 µg/dL (IQR = 64, 84) in the retrospective non-COVID-19 control group (N = 1513; p <.001). Markedly, the absolute majority of COVID-19 patients (96%) were zinc deficient (<80 µg/dL). The median zinc concentration was lower in patients with CRS compared to those without CRS (-5 µg/dL; 95% CI = -10.5, 0.051; p = 0.048). Among the tested outcomes, zinc concentration is significantly correlated with only the length of hospital stay (rho = -0.19; p = 0.022), but not with mortality or morbidity. As such, our findings do not support the role of zinc as a robust prognostic marker among hospitalized COVID-19 patients who in our cohort presented a high prevalence of zinc deficiency. It might be more beneficial to explore the role of zinc as a biomarker for assessing the risk of developing a tissue-damaging CRS and predicting outcomes in patients diagnosed with COVID-19 at the early stage of the disease.

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.…”

“…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. Serum zinc concentrations are influenced by malnutrition, aging, pregnancy, iatrogenic diseases, and chronic diseases (diabetes mellitus, gastrointestinal disease, renal failure, etc.)…”

Quantitative Analysis of Residual COVID-19 Lung CT Features: Consistency among Two Commercial Software

“…A new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) is the pathogen responsible for the SARS-CoV-2 disease (COVID- 19), which has spread throughout the world since December 2019 [1][2][3][4][5][6][7][8][9]. COVID-19 was defined as a pandemic by the World Health Organization on 11 March 2020 [10].…”

“…COVID-19 was defined as a pandemic by the World Health Organization on 11 March 2020 [10]. The clinical expressions of COVID-19 range from flu-like symptoms to respiratory failure, the management of which demands advanced respiratory assistance and artificial ventilation [11][12][13][14][15][16][17][18][19][20][21]. The clinical spectrum of COVID-19 pneumonia ranges from mild to critical cases, among which the diagnosis of ordinary, severe, and critical cases was related to chest computed tomography (CT) findings [22,23].…”