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0 0.5 1 1.5 2+ Ventilation 49% Improvement Relative Risk ICU admission 52% Zinc  Tomasa-Irriguible et al.  Sufficiency Are zinc levels associated with COVID-19 outcomes? Retrospective 120 patients in Spain (March - May 2020) Lower ICU admission with higher zinc levels (p=0.017) c19early.org Tomasa-Irriguible et al., Metabolites, Oct 2020 Favors zinc Favors control

Low Levels of Few Micronutrients May Impact COVID-19 Disease Progression: An Observational Study on the First Wave

Tomasa-Irriguible et al., Metabolites, doi:10.3390/metabo11090565 (date from preprint)
Oct 2020  
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Zinc for COVID-19
2nd treatment shown to reduce risk in July 2020
 
*, now known with p = 0.0000013 from 44 studies, recognized in 11 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments. c19early.org
Retrospective 120 hospitalized patients in Spain showing zinc deficiency associated with higher ICU admission.
Study covers vitamin A, vitamin D, and zinc.
risk of mechanical ventilation, 49.3% lower, RR 0.51, p = 0.06, high zinc levels 7 of 31 (22.6%), low zinc levels 49 of 89 (55.1%), NNT 3.1, adjusted per study, inverted to make RR<1 favor high zinc levels, odds ratio converted to relative risk, ≥84 mcg/dL, multivariate logistic regression.
risk of ICU admission, 52.0% lower, RR 0.48, p = 0.02, high zinc levels 9 of 31 (29.0%), low zinc levels 55 of 89 (61.8%), NNT 3.1, adjusted per study, inverted to make RR<1 favor high zinc levels, odds ratio converted to relative risk, ≥84 mcg/dL, multivariate logistic regression, final model.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Tomasa-Irriguible et al., 26 Oct 2020, retrospective, Spain, peer-reviewed, 7 authors, study period March 2020 - May 2020.
This PaperZincAll
Low Levels of Few Micronutrients May Impact COVID-19 Disease Progression: An Observational Study on the First Wave
Teresa-Maria Tomasa-Irriguible, Lara Bielsa-Berrocal, Luisa Bordejé-Laguna, Cristina Tural-Llàcher, Jaume Barallat, Josep-Maria Manresa-Domínguez, Pere Torán-Monserrat
Metabolites, doi:10.3390/metabo11090565
We report an observational study performed between March and May 2020 in a Spanish university hospital during the SARS-CoV-2 pandemic. The main objective was to analyse the association between the levels of micronutrients in severe COVID-19 patients and their outcome. Adult patients with a positive polymerase-chain-reaction (PCR) for SARS-CoV-2 in the nasopharyngeal swab or in tracheal aspirate culture in the case of intubation were included. Micronutrient data were obtained from plasma analysis of a standard nutritional assessment performed within the first 24 h of hospital admission. Vitamins A, B 6 , C and E were analysed with HPLC methods; 25-OH-vitamin D by immunoassay and zinc by colorimetric measurements. One hundred and twenty patients were included. We found that 74.2% patients had low levels of zinc (normal levels >84 µg/dL) with a mean value of 63.5 (SD 13.5); 71.7% patients had low levels of vitamin A (normal levels >0.3 mg/L) with a mean value of 0.17 (SD 0.06); 42.5% patients had low levels of vitamin B 6 (normal levels >3.6 ng/mL) with a mean value of 2.2 (SD 0.9); 100% patients had low levels of vitamin C (normal levels >0.4 mg/dL) with a mean value of 0.14 (SD 0.05); 74.3% patients had low values of vitamin D (normal levels >20 ng/mL) with mean value of 11.4 (SD 4.3); but only 5.8% of patients had low levels of vitamin E (normal levels >5 mg/L) with a mean value of 3.95 (SD 0.87). The variables associated with the need for ICU admission were low levels of zinc (standard error 0.566, 95% CI 0.086 to 0.790, p = 0.017), low levels of vitamin A (standard error 0.582, 95% CI 0.061 to 0.594, p = 0.004), age over 65 (standard error 0.018, 95% CI 0.917 to 0.985, p = 0.005) and male gender (standard error 0.458, 95% CI 1.004 to 6.040, p = 0.049). The only variable that was independently associated with the need for orotracheal intubation was low levels of vitamin A (standard error 0.58, 95% CI 0.042 to 0.405, p = 0.000). Conclusions: Low levels of vitamin A and zinc are associated with a greater need for admission to the ICU and orotracheal intubation. Patients older than 65 years had higher mortality. Randomized clinical trials are needed to examine whether micronutrient supplementation could be beneficial as an adjunctive treatment in COVID-19.
Informed Consent Statement: Patient consent was waived due to the retrospective analyses of data obtained from an anonymized data base obtained from the Information Systems of the Center. Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
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We found that 74.2% patients had low levels of ' 'zinc (normal levels &gt;84 µg/dL) with a mean value of 63.5 (SD 13.5); 71.7% patients had low ' 'levels of vitamin A (normal levels &gt;0.3 mg/L) with a mean value of 0.17 (SD 0.06); 42.5% ' 'patients had low levels of vitamin B6 (normal levels &gt;3.6 ng/mL) with a mean value of 2.2 ' '(SD 0.9); 100% patients had low levels of vitamin C (normal levels &gt;0.4 mg/dL) with a mean ' 'value of 0.14 (SD 0.05); 74.3% patients had low values of vitamin D (normal levels &gt;20 ' 'ng/mL) with mean value of 11.4 (SD 4.3); but only 5.8% of patients had low levels of vitamin ' 'E (normal levels &gt;5 mg/L) with a mean value of 3.95 (SD 0.87). The variables associated ' 'with the need for ICU admission were low levels of zinc (standard error 0.566, 95% CI 0.086 ' 'to 0.790, p = 0.017), low levels of vitamin A (standard error 0.582, 95% CI 0.061 to 0.594, p ' '= 0.004), age over 65 (standard error 0.018, 95% CI 0.917 to 0.985, p = 0.005) and male ' 'gender (standard error 0.458, 95% CI 1.004 to 6.040, p = 0.049). The only variable that was ' 'independently associated with the need for orotracheal intubation was low levels of vitamin A ' '(standard error 0.58, 95% CI 0.042 to 0.405, p = 0.000). Conclusions: Low levels of vitamin A ' 'and zinc are associated with a greater need for admission to the ICU and orotracheal ' 'intubation. Patients older than 65 years had higher mortality. 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