COVID-19: Poor outcomes in patients with zinc deficiency

• Published in: International journal of infectious diseases Vol. 100; pp. 343 - 349
• Main Authors: Jothimani, Dinesh, Kailasam, Ezhilarasan, Danielraj, Silas, Nallathambi, Balaji, Ramachandran, Hemalatha, Sekar, Padmini, Manoharan, Shruthi, Ramani, Vidyalakshmi, Narasimhan, Gomathy, Kaliamoorthy, Ilankumaran, Rela, Mohamed
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.11.2020; Published by Elsevier Ltd on behalf of International Society for Infectious Diseases; Elsevier
• Subjects: Adolescent; Adult; Aged; Antiviral Agents - therapeutic use; COVID-19; COVID-19 - blood; COVID-19 - complications; COVID-19 - therapy; Female; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Odds Ratio; Pandemics; Prospective Studies; SARS-CoV-2; Treatment Outcome; Young Adult; Zinc; Zinc - blood; Zinc - deficiency; COVID-19; SARS-CoV-2; Zinc
• DOI: 10.1016/j.ijid.2020.09.014
• ISSN: 1201-9712; 1878-3511

•Patients with coronavirus disease 2019 (COVID-19) had significantly low zinc levels in comparison to healthy controls.•Zinc deficient patients developed more complications (70.4% vs 30.0%, p = 0.009).•Zinc deficient COVID-19 patients had a prolonged hospital stay (7.9 vs 5.7 days, p = 0.048).•In vitro studies have shown that reduced zinc levels favour the interaction of angiotensin-converting enzyme 2 (ACE2) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and likewise that increased zinc levels inhibit ACE2 expression resulting in reduced viral interaction. Zinc is a trace element with potent immunoregulatory and antiviral properties, and is utilized in the treatment of coronavirus disease 2019 (COVID-19). However, we do not know the clinical significance of serum Zinc levels in COVID-19 patients. The aim of this study was to determine the clinical significance of serum zinc in COVID-19 patients and to establish a correlation with disease severity. This was a prospective study of fasting zinc levels in COVID-19 patients at the time of hospitalization. An initial comparative analysis was conducted between COVID-19 patients and healthy controls. COVID-19 patients with zinc deficiency were compared to those with normal zinc levels. COVID-19 patients (n = 47) showed significantly lower zinc levels when compared to healthy controls (n = 45): median 74.5 (interquartile range 53.4–94.6) μg/dl vs 105.8 (interquartile range 95.65–120.90) μg/dl (p < 0.001). Amongst the COVID-19 patients, 27 (57.4%) were found to be zinc deficient. These patients were found to have higher rates of complications (p = 0.009), acute respiratory distress syndrome (18.5% vs 0%, p = 0.06), corticosteroid therapy (p = 0.02), prolonged hospital stay (p = 0.05), and increased mortality (18.5% vs 0%, p = 0.06). The odds ratio (OR) of developing complications was 5.54 for zinc deficient COVID-19 patients. The study data clearly show that a significant number of COVID-19 patients were zinc deficient. These zinc deficient patients developed more complications, and the deficiency was associated with a prolonged hospital stay and increased mortality.