Urinary trace elements in association with disease severity and outcome in patients with COVID-19

Abstract

Background The dynamics of urinary trace elements in patients with COVID-19 still remains to be investigated. Methods A retrospective study was performed on a cohort of 138 confirmed COVID-19 patients for their urinary levels of essential and/or toxic metals including chromium, manganese, copper, arsenic, selenium, cadmium, mercury, thallium and lead according to the different disease severity (severe or non-severe) and outcome (recovered or deceased). Results Urinary concentrations of chromium, manganese, copper, selenium, cadmium, mercury and lead after creatinine adjustment were found to be higher in severe patients than the non-severe cases with COVID-19. And among the severe cases, these elements were also higher in the deceased group than the recovered group. When the weeks of the post-symptom onset were taken in account, the changes of these urinary elements were existed across the clinical course since the disease onset. These urinary elements were found to be mostly positively inter-correlated, and further positively correlated with other laboratory inflammatory parameters including serum cytokines (IL-1B, IL2R, IL6, IL8, IL10, TNFα), ferritin, and neutrophil count and white blood cell count. As a independently predictive factor, urinary creatinine-adjusted copper of ≥ 25.57 μg/g and ≥ 99.32 μg/g were associated with significantly increased risk of severe illness and fatal outcome in COVID-19, respectively. Conclusions These results suggest abnormities in urinary levels of the trace metals were tightly associated with the severe illness and fatal outcome of COVID-19.

The effects of some essential and toxic metals/metalloids in COVID-19: A review

“…The levels of selenium, zinc, magnesium and copper were significantly lower in COVID-19 patients than in controls, while chromium did not show significant differences. On the other hand, Zeng et al (2021a) determined in COVID-19 patients the urinary levels of various essential and toxic metals/metalloids, including arsenic, cadmium, chromium, copper, lead, manganese, mercury, selenium and thallium, in order to establish the potential relationship with the severity of the disease (either severe or non-severe) and the outcomes (recovered or deceased). The urinary concentrations of most analyzed elements were found to be higher in severe patients than in the non-severe cases.…”

“…Based on the evidence showing that cadmium’s mode of pulmonary toxicity probably occurs through immunotoxicity and amplifying inflammation, these researchers suggested that would be possible that higher cadmium burdens could worsen outcomes from COVID-19 infections, for which evidence suggests that the main mechanism involves marked amplification of inflammation ( Fu et al, 2020 ). On the other hand, Zeng et al (2021a) showed that the urinary concentrations of various metals/metalloids (chromium, manganese, copper, cadmium, mercury, arsenic and thallium) were associated with the prognosis of severe COVID-19. These authors have recommended that trace elements should be persistently monitored, not being only useful for the identification of COVID-19, but also as a help for the evaluation of the dynamic changes that appear in COVID-19 patients.…”

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

“…The latest evidence on coronaviruses indicates that nutritional and metabolic derangements are associated with the disease severity and susceptibility to infection (Jayawardena R. et al, 2020, Lv et al, 2020 , Singer, 2021 , Zeng et al, 2021 ). In this study, we measured serum trace elements status in severe and non-severe COVID-patients.…”

“…There is little information regarding Mn effect on immune development and COVID-19 pathogenesis. In a recently published study, liver dysfunction in severe COVID-19 was suspected to be associated with higher urinary Mn levels ( Zeng et al, 2021 ). Our results indicated lower Mn levels were associated with age more than 55 years, indicating feeding this group with a low Mn diet and a possible susceptibility to disease.…”

Mass Spectrometry-Based Human Breath Analysis: Towards COVID-19 Diagnosis and Research

“…Thus, the balance of mineral status in body fluids and exhaled breath of COVID-19 patients might be significantly influenced through a yet-to-be-discovered bioinorganic mechanism. Zeng et al [ 26 , 28 ] applied ICP-MS to determinate various elements, including Mn, Ca, Cr, Mn, Fe, Cu, Zn, As, Cd, Hg, Tl, Pb, and others from COVID-19 and non-severe COVID-19 patients’ body fluids. These studies revealed that significant variations of elements associated with the disease development of COVID-19 can be performed using ICP-MS.…”