Abstract: [
Chest Infections Research Letter
]
The Minimal Effect of Zinc on
the Survival of Hospitalized
Patients With COVID-19
An Observational Study
To the Editor:
Zinc is an investigational agent against coronavirus
disease 2019 (COVID-19) and has known preventative
and therapeutic roles in other infections.1-3 Zinc
deficiency is associated with lower survival among older
patients with pneumonia and predisposes to other viral
infections.3 Established risk factors for critical COVID-19,
including older age, diabetes mellitus, and cardiovascular
disease, are also associated with zinc deficiency.2
The antiviral and immunomodulatory effects of zinc
have made it a candidate against severe acute respiratory
Methods
In this single-institution retrospective study, we assessed the survival of
hospitalized patients with COVID-19 treated with vs without zinc
sulfate. This study was conducted in accordance with the amended
Declaration of Helsinki. This study’s protocol was approved and was
granted a waiver of informed consent by the hospital board on April
15, 2020, based on its retrospective design and the lack of identifying
information to be published, collected, or analyzed.
Data of all patients with COVID-19 (N ¼ 242) admitted at the Hoboken
University Medical Center until April 11, 2020, were retrospectively
collected on April 21, 2020. COVID-19 was confirmed in all patients
using quantitative real-time reverse transcription polymerase chain
reaction for SARS-CoV-2 RNA. Clinical severity was stratified based
on World Health Organization8 guidelines according to clinical,
radiographic, and laboratory information from the first 24 h of
admission. The primary outcome was days from admission to inhospital mortality. Data for patients who did not meet the primary
outcome were censored on April 21, 2020.
Our primary analysis explored the causal association between zinc therapy
and the survival of hospitalized patients with COVID-19. Inverse
probability weighting (IPW) and a censorship model derived an effect
estimate of zinc therapy on survival using the parameter defined as the
Results
Of 242 patients, 81.0% received zinc sulfate at a total
daily dose of 440 mg (100 mg elemental zinc). The
median age of patients who received zinc was 65 years
(interquartile range, 53-77), whereas that of the control
108 Research Letter
syndrome-coronavirus-2 (SARS-CoV-2) infection.2-4
Zinc may decrease the activity of the angiotensin
converting enzyme 2, the receptor for SARS-CoV-2.
Zinc T-cell modulation may downregulate the cytokine
storm associated with severe COVID-19.2,4 These
properties underlie the speculated efficacy of
chloroquine, a zinc ionophore, and the derivative
hydroxychloroquine, which are investigational agents
in the worldwide World Health Organization
SOLIDARITY trial.2,5,6 Furthermore, chloroquine may
increase cellular zinc uptake, suggesting therapeutic
benefit from the combination of the two agents.4
Despite zinc’s low risk of adverse effects, zinc’s role
in the management of COVID-19 must be
supported by clinical data.7 Therefore, we
investigated the role of zinc among hospitalized
patients with COVID-19.
average treatment effect on the treated (ATET). The lack of sufficient
overlap or the positive probability of assignment to each treatment level
precluded the estimation of the average treatment effect.
Multivariable logistic regression modeled the propensity to receive zinc
by assigning weights to established predictors of mortality and..
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