Essential metals, vitamins and antioxidant enzyme activities in COVID-19 patients and their potential associations with the disease severity
Iman Al-Saleh, Alrushud Nujud, Alnuwaysir Hissah, Elkhatib Rola, Shoukri Mohamed, Aldayel Fouad, Bakheet Maha Razan, Almozaini, N Alrushud, Á H Alnuwaysir, Á R Elkhatib, M Shoukri, F Aldayel, R Bakheet, M Almozaini
doi:10.1007/s10534-021-00355-4(
The role of micronutrient deficiency in the pathogenesis of COVID-19 has been reviewed in the literature; however, the data are limited and conflicting. This study investigated the association between the status of essential metals, vitamins, and antioxidant enzyme activities in COVID-19 patients and disease severity. We recruited 155 patients, who were grouped into four classes based on the Adults guideline for the Management of Coronavirus Disease 2019 at King Faisal Specialist & Research Centre (KFSH&RC): asymptomatic (N = 16), mild (N = 49), moderate (N = 68), and severe (N = 22). We measured serum levels of copper (Cu), zinc (Zn), selenium (Se), vitamin D 3 , vitamin A, vitamin E, total antioxidant capacity, and superoxide dismutase (SOD). Among the patients, 30%, 25%, 37%, and 68% were deficient in Se (\ 70.08 lg/L), Zn (\ 0.693 lg/mL), vitamin A (\ 0.343 lg/mL), and vitamin D 3 (\ 20.05 lg/L), respectively, and SOD activity was low. Among the patients, 28% had elevated Cu levels ([ 1.401 lg/mL, KFSH&RC upper reference limit). Multiple regression analysis revealed an 18% decrease in Se levels in patients with severe symptoms, which increased to 30% after adjusting the model for inflammatory markers. Regardless of inflammation, Se was independently associated with COVID-19 severity. In contrast, a 50% increase in Cu levels was associated with disease severity only after adjusting for C-reactive protein, reflecting its possible inflammatory and pro-oxidant role in COVID-19 pathogenesis. We noted an imbalance in the ratio between Cu and Zn, with * 83% of
Author contributions IAS-study design, data analysis, results interpretation and writing the manuscript. NA-collection of clinical data. HA-methodology/validation. REmethodology/validation. MS-sampling design. FA-samples provision. RB-methodology. MA-resources.
Conflict of interest The authors reported no potential conflict of interest.
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