Plasma zinc status and hyperinflammatory syndrome in hospitalized COVID-19 patients: an observational study
Gil Verschelden, Maxim Noeparast, Maryam Noparast, Maïlis Lauwers, Charlotte Michel, Frédéric Cotton, Cleo Goyvaerts, Maya Hites
doi:10.1101/2021.06.09.21258271
Deficiency of the element zinc is associated with cytokine releasing syndrome (CRS) and the related acute respiratory distress syndrome as well as impaired antiviral response. Similar complications associate with severe SARS-CoV-2. We conducted a prospective, single-center, observational study in a tertiary university hospital (CUB-Hopital Erasme, Brussels) to address the zinc status, the association between the plasma zinc concentration, development of CRS, and the clinical outcomes in PCR-confirmed and hospitalized COVID-19 patients. One hundred and thirty-nine eligible patients were included between May 2020 and November 2020 (median age of 65 years [IQR, 54 to 77]). Our cohort's mean plasma zinc concentration was 56.2 µg/dL (standard deviation [SD], 14.8) compared to 75.7 µg/dL (SD = 18.9 µg/dL) in the retrospective non-COVID-19 control group (N = 1513; P <.001). Markedly, the absolute majority of patients (96%) were zinc deficient (<80 µg/dL).
Ethics approval and consent to participate Informed consent was obtained from all participants. The study was approved by the ethics committee of Erasme Hospital, EC identifier P2020/261. Conflict of interest and funding: We hereby confirm that there is no conflict of interest associated with this publication and that this work did not receive any financial support that could have influenced its outcome.
Author contributions G.V and M.Noep: conceived the idea, co-authored the research proposal, designed the study, analyzed the data, interpreted the results, generated the tables, and coauthored the manuscript. G.V: medical consultation and handling the patients' material. M.Nop: supervised the study design and the statistical analyses and critically revised and contributed to drafting the manuscript. M.L, C.M, F.C: handled the patients' material and performed the laboratory assessments. C.G: contributed to . Note: IQR = interquartile range, CI = confidence interval, OR = odds ratio
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"abstract": "<jats:title>Abstract</jats:title><jats:p>Deficiency of the element zinc is associated with cytokine releasing syndrome (CRS) and the related acute respiratory distress syndrome as well as impaired antiviral response. Similar complications associate with severe SARS-CoV-2.</jats:p><jats:p>We conducted a prospective, single-center, observational study in a tertiary university hospital (CUB-Hopital Erasme, Brussels) to address the zinc status, the association between the plasma zinc concentration, development of CRS, and the clinical outcomes in PCR-confirmed and hospitalized COVID-19 patients. One hundred and thirty-nine eligible patients were included between May 2020 and November 2020 (median age of 65 years [IQR, 54 to 77]).</jats:p><jats:p>Our cohort’s mean plasma zinc concentration was 56.2 µg/dL (standard deviation [SD], 14.8) compared to 75.7 µg/dL (SD = 18.9 µg/dL) in the retrospective non-COVID-19 control group (N = 1513;<jats:italic>P</jats:italic><.001). Markedly, the absolute majority of patients (96%) were zinc deficient (<80 µg/dL).</jats:p><jats:p>The mean zinc concentration was lower in patients with CRS compared to those without CRS (−5 µg/dL; 95% CI, -10.5 to 0.051;<jats:italic>P</jats:italic>= 0.048).</jats:p><jats:p>Among the tested outcomes, zinc concentration is significantly correlated with only the length of hospital stay (rho = -0.19;<jats:italic>P</jats:italic>= 0.022), but not with mortality or morbidity. As such, our findings do not support the role of zinc as a robust prognostic marker among hospitalized COVID-19 patients who in our cohort presented high prevalence of zinc deficiency. It might be more beneficial to explore the role of zinc as a biomarker for assessing the risk of developing a tissue-damaging CRS and predicting outcomes in patients diagnosed with COVID-19 at the early stage of the disease.</jats:p>",
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