Evaluation of zinc sulfate as an adjunctive therapy in COVID-19 critically ill patients: a two center propensity-score matched study
Khalid Al Sulaiman, Ohoud Aljuhani, Abdulrahman I Al Shaya, Abdullah Kharbosh, Raed Kensara, Alhomaidi Al Guwairy, Aisha Alharbi, Rahmah Algarni, Shmeylan Al Harbi, Ramesh Vishwakarma, Ghazwa B Korayem
Critical Care, doi:10.1186/s13054-021-03785-1
Background: Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19. Methods: Patients aged ≥ 18 years with COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use from March 1, 2020 until March 31, 2021. After propensity score matching (1:1 ratio) based on the selected criteria, we assessed the association of zinc used as adjunctive therapy with the 30-day mortality. Secondary outcomes included the in-hospital mortality, ventilator free days, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay. Results: A total of 164 patients were included, 82 patients received zinc. Patients who received zinc sulfate as adjunctive therapy have a lower 30-day mortality (HR 0.52, CI 0.29, 0.92; p = 0.03). On the other hand, the in-hospital mortality was not statistically significant between the two groups (HR 0.64, CI 0.37-1.10; p = 0.11). Zinc sulfate use was associated with a lower odds of acute kidney injury development during ICU stay (OR 0.46 CI 0.19-1.06; p = 0.07); however, it did not reach statistical significance.
Conclusion: The use of zinc sulfate as an additional treatment in critically ill COVID-19 patients may improve survival. Furthermore, zinc supplementation may have a protective effect on the kidneys.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s13054-021-03785-1.
Additional file 1: Table e1 Patients Baseline characteristics before and after propensity-score matching.
Authors' contributions KS and OA equally contributed to the conception and design of the research; AS, GK, AK, SA, RK, RV and AA contributed to the design of the research; KS, OA, AS, GK, AK, SA, RK, RV, AAB, RG and AA contributed to the acquisition and analysis of the data; KS, OA, AS, GK contributed to the interpretation of the data; KS, OA, AS, SA, AK, RK, AA, AAB, RG and RV drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.
Declarations Ethics approval and consent to participate The study was approved in November 19th, 2020 by King Abdullah International Medical Research Center Institutional Review Board, Riyadh, Saudi Arabia (Reference No: RC20/589/R). Participants' confidentiality was strictly observed throughout the study using the anonymous unique serial number for each subject and restricting data only to the investigators. Informed consent was not required due to the research's method as per the policy of the governmental and local research center.
Consent for publication Not applicable.
Competing interests The authors declare that they have no competing..
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