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Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS

Notz et al., Nutrients, doi:10.3390/nu13062113
Jun 2021  
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Zinc for COVID-19
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Retrospective 22 ICU patients, showing most patients had low selenium status biomarkers and low zinc levels, and reporting on treatment with nutrient supplementation including selenium and zinc. Authors conclude that sufficient selenium and zinc levels may be important for an adequate immune response in critically ill patients with severe COVID-19 ARDS.
Study covers selenium and zinc.
Notz et al., 20 Jun 2021, retrospective, Germany, peer-reviewed, 13 authors.
This PaperZincAll
Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS
Quirin Notz, Johannes Herrmann, Tobias Schlesinger, Philipp Helmer, Stephan Sudowe, Qian Sun, Julian Hackler, Daniel Roeder, Christopher Lotz, Patrick Meybohm, Peter Kranke, Lutz Schomburg, Christian Stoppe
Nutrients, doi:10.3390/nu13062113
The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (r s = −0.495), PCT (r s = −0.413), IL-6 (r s = −0.429), IL-1β (r s = −0.440) and IL-10 (r s = −0.461). Positive associations were found for CD8 + T cells (r s = 0.636), NK cells (r s = 0.772), total IgG (r s = 0.493) and PaO 2 /FiO 2 ratios (r s = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.
Conflicts of Interest: Stephan Sudowe is employed at Ganzimmun Diagnostics AG. Lutz Schomburg holds shares in selenOmed GmbH, a company involved in Se status assessment and supplementation. Christian Stoppe reports grants and non-financial support from Biosyn Arzneimittel GmbH, outside the submitted work. The other authors declare no competing interest.
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{ 'indexed': {'date-parts': [[2024, 5, 9]], 'date-time': '2024-05-09T16:36:35Z', 'timestamp': 1715272595114}, 'reference-count': 64, 'publisher': 'MDPI AG', 'issue': '6', 'license': [ { 'start': { 'date-parts': [[2021, 6, 20]], 'date-time': '2021-06-20T00:00:00Z', 'timestamp': 1624147200000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'abstract': '<jats:p>The interplay between inflammation and oxidative stress is a vicious circle, ' 'potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and ' 'zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. ' 'This single-center retrospective study investigated micronutrient levels under Se and Zn ' 'supplementation in critically ill patients with COVID-19 induced acute respiratory distress ' 'syndrome (ARDS) and explored potential relationships with immunological and clinical ' 'parameters. According to intensive care unit (ICU) standard operating procedures, patients ' 'received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained ' 'various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and ' 'clinical data were extracted from the patient data management system on admission and after ' '10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients ' 'were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 ' 'patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se ' 'status biomarkers and Zn levels, along with elevated inflammatory parameters. Se ' 'supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p ' '= 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased ' 'over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with ' 'CRP (rs = −0.495), PCT (rs = −0.413), IL-6 (rs = −0.429), IL-1β (rs = −0.440) and IL-10 (rs = ' '−0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = ' '0.772), total IgG (rs = 0.493) and PaO2/FiO2 ratios (rs = 0.504). In addition, survivors ' 'tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). 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Late treatment
is less effective
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