Selenium Deficiency Is Associated with Mortality Risk from COVID-19

Abstract

SARS-CoV-2 infections underlie the current coronavirus disease (COVID-19) pandemic and are causative for a high death toll particularly among elderly subjects and those with comorbidities. Selenium (Se) is an essential trace element of high importance for human health and particularly for a well-balanced immune response. The mortality risk from a severe disease like sepsis or polytrauma is inversely related to Se status. We hypothesized that this relation also applies to COVID-19. Serum samples (n = 166) from COVID-19 patients (n = 33) were collected consecutively and analyzed for total Se by X-ray fluorescence and selenoprotein P (SELENOP) by a validated ELISA. Both biomarkers showed the expected strong correlation (r = 0.7758, p < 0.001), pointing to an insufficient Se availability for optimal selenoprotein expression. In comparison with reference data from a European cross-sectional analysis (EPIC, n = 1915), the patients showed a pronounced deficit in total serum Se (mean ± SD, 50.8 ± 15.7 vs. 84.4 ± 23.4 µg/L) and SELENOP (3.0 ± 1.4 vs. 4.3 ± 1.0 mg/L) concentrations. A Se status below the 2.5th percentile of the reference population, i.e., [Se] < 45.7 µg/L and [SELENOP] < 2.56 mg/L, was present in 43.4% and 39.2% of COVID samples, respectively. The Se status was significantly higher in samples from surviving COVID patients as compared with non-survivors (Se; 53.3 ± 16.2 vs. 40.8 ± 8.1 µg/L, SELENOP; 3.3 ± 1.3 vs. 2.1 ± 0.9 mg/L), recovering with time in survivors while remaining low or even declining in non-survivors. We conclude that Se status analysis in COVID patients provides diagnostic information. However, causality remains unknown due to the observational nature of this study. Nevertheless, the findings strengthen the notion of a relevant role of Se for COVID convalescence and support the discussion on adjuvant Se supplementation in severely diseased and Se-deficient patients.

Selenium and RNA Virus Interactions: Potential Implications for SARS-CoV-2 Infection (COVID-19)

“…In the first part, we reviewed the current evidence on how RNA virus can mutate, replicate and become more virulent in Se-deficient environment. There is now evidence that SARS-CoV-2 behaves similarly with the recent study from Zhang et al (28) showing the link between COVID-19 recovery rate and the Se population status in 17 Chinese cities and Moghaddam et al pointing at a strong correlation with low Se status and poor outcome in hospitalized patients (29) It is also important to note that SARS-Cov-2 Spike Protein S mutated (D614G) leading to an apparently more infectious strain now dominant in the Western regions as in the US (113,114). Se presents various potential interests that can be applied to COVID-19 (115,116).…”

“…This observation, like the Hou's study cited above for epidemic hemorrhagic fever (16), goes against the conventional wisdom that there is no benefit in Se supplementation above the minimum required dietary intake. These population based data have been recently confirmed in clinical practice in a study by Moghaddam et al in Germany (29). They showed that serum Se levels were highly correlated with COVID-19 outcome in hospitalized patients.…”

“…Previous studies on Hantavirus infection and sepsis in ICU have demonstrated good tolerance of higher dosages of selenite for acute treatment (16,51,127). This would seem appropriate and safe for a very short period of two to three weeks in order to replenish selenium stock (29) in this impending life-threatening condition. In the hospital, the intravenous form is undoubtedly more suitable given a large number of digestive disorders in the context of COVID-19.…”

Clinical Impact Potential of Supplemental Nutrients as Adjuncts of Therapy in High-Risk COVID-19 for Obese Patients

“…The expression of these selenoproteins is decreased in obese individuals due to their lower Se status (178). In COVID-19, selenoprotein expression may also be reduced by inflammatory factors and suppressed immune status (179). Therefore, dietary Se supplementation may help alleviate the respiratory and inflammatory clinical symptoms in obese patients suffering from COVID-19.…”

Mikronährstoffe, Immunüberwachung und Immunseneszenz

“…Darüber hinaus waren die Se-Spiegel bei überlebenden Patienten, die wieder von der Intensivstation entlassen werden konnten, signifikant höher als bei den verstorbenen Patienten (Serum-Se ca. 53 vs. 41 µg/l) [21]. Basierend auf einem systematischen Review wurde zudem nahezu zeitgleich eine Stellungnahme der European Society for Clinical Nutrition and Metabolism (ESPEN) publiziert [22], die die Bestimmung von Mikronährstoffen bei Covid-19-Patienten empfiehlt, u. a. Vitamin D, Zink und Selen.…”