Low Zinc Levels at Admission Associates with Poor Clinical Outcomes in SARS-CoV-2 Infection
Marina Vogel-González, Marc Talló-Parra, Víctor Herrera-Fernández, Gemma Pérez-Vilaró, Miguel Chillón, Xavier Nogués, Silvia Gómez-Zorrilla, Inmaculada López-Montesinos, Isabel Arnau-Barrés, Maria Luisa Sorli-Redó, Juan Pablo Horcajada, Natalia García-Giralt, Julio Pascual, Juana Díez, Rubén Vicente, Robert Güerri-Fernández
Nutrients, doi:10.3390/nu13020562
Background: Zinc is an essential micronutrient that impacts host-pathogen interplay at infection. Zinc balances immune responses, and also has a proven direct antiviral action against some viruses. Importantly, zinc deficiency (ZD) is a common condition in elderly and individuals with chronic diseases, two groups with an increased risk for severe severe coronavirus disease 2019 (COVID-19) outcomes. We hypothesize that serum zinc content (SZC) influences COVID-19 disease progression, and thus might represent a useful biomarker. Methods: We ran an observational cohort study with 249 COVID-19 patients admitted in Hospital del Mar. We have studied COVID-19 severity and progression attending to SZC at admission. In parallel, we have studied severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) replication in the Vero E6 cell line modifying zinc concentrations. Findings: Our study demonstrates a correlation between serum zinc levels and COVID-19 outcome. Serum zinc levels lower than 50 µg/dL at admission correlated with worse clinical presentation, longer time to reach stability, and higher mortality. Our in vitro results indicate that low zinc levels favor viral expansion in SARS-CoV-2 infected cells. Interpretation: Low SZC is a risk factor that determines COVID-19 outcome. We encourage performing randomized clinical trials to study zinc supplementation as potential prophylaxis and treatment with people at risk of zinc deficiency.
Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and was approved by the Institutional Review Board (IRB; the Institutional Ethics Committee of the Hospital del Mar of Barcelona (CEIm-2020/9352)). Due to the nature of the retrospective data review, the IRB waived the need for informed consent from individual patients. Informed Consent Statement: Due to the nature of the retrospective data review, the IRB waived the need for informed consent from individual patients.
Conflicts of Interest: The authors declare no conflict of interest.
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'abstract': '<jats:p>Background: Zinc is an essential micronutrient that impacts host–pathogen interplay '
'at infection. Zinc balances immune responses, and also has a proven direct antiviral action '
'against some viruses. Importantly, zinc deficiency (ZD) is a common condition in elderly and '
'individuals with chronic diseases, two groups with an increased risk for severe severe '
'coronavirus disease 2019 (COVID-19) outcomes. We hypothesize that serum zinc content (SZC) '
'influences COVID-19 disease progression, and thus might represent a useful biomarker. '
'Methods: We ran an observational cohort study with 249 COVID-19 patients admitted in Hospital '
'del Mar. We have studied COVID-19 severity and progression attending to SZC at admission. In '
'parallel, we have studied severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) '
'replication in the Vero E6 cell line modifying zinc concentrations. Findings: Our study '
'demonstrates a correlation between serum zinc levels and COVID-19 outcome. Serum zinc levels '
'lower than 50 µg/dL at admission correlated with worse clinical presentation, longer time to '
'reach stability, and higher mortality. Our in vitro results indicate that low zinc levels '
'favor viral expansion in SARS-CoV-2 infected cells. Interpretation: Low SZC is a risk factor '
'that determines COVID-19 outcome. We encourage performing randomized clinical trials to study '
'zinc supplementation as potential prophylaxis and treatment with people at risk of zinc '
'deficiency.</jats:p>',
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