Abstract
Selenium (Se) and zinc (Zn) are essential trace elements needed for appropriate immune system responses, cell signalling and anti-viral defence. A cross-sectional observational study was conducted at two hospitals in Ghent, Belgium, to investigate whether Se and/or Zn deficiency upon hospital admission correlates to disease severity and mortality risk in COVID-19 patients with or without co-morbidities. Trace element concentrations along with additional biomarkers were determined in serum or plasma and associated to disease severity and outcome. An insufficient Se and/or Zn status upon hospital admission was associated with a higher mortality rate and a more severe disease course in the entire study group, especially in the senior population. In comparison to healthy European adults, the patients displayed strongly depressed total Se (mean ± SD: 59.2 ± 20.6 vs. 84.4 ± 23.4 µg L−1) and SELENOP (mean ± SD: 2.2 ± 1.9 vs. 4.3 ± 1.0 mg L−1) concentrations at hospital admission. Particularly strong associations were observed for death risk of cancer, diabetes and chronic cardiac disease patients with low Se status, and of diabetes and obese patients with Zn deficiency. A composite biomarker based on serum or plasma Se, SELENOP and Zn at hospital admission proved to be a reliable tool to predict severe COVID-19 course and death, or mild disease course. We conclude that trace element assessment at hospital admission may contribute to a better stratification of patients with COVID-19 and other similar infectious diseases, support clinical care, therapeutic interventions and adjuvant supplementation needs, and may prove of particular relevance for patients with relevant comorbidities.
Highlights
The infectious coronavirus disease (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) constitutes a life-threatening condition, in particular for a subgroup of patients with underlying comorbidities
We investigated the possible interrelationship between COVID-19 severity and mortality risk with the trace element status and the prevalent comorbidities diabetes mellitus, obesity, chronic cardiac disease and cancer
Zn status were determined as total element concentrations in plasma, whereas Se status was assessed by three interrelated biomarkers, i.e., total Se concentration, SELENOP levels and GPX3 activities
Summary
The infectious coronavirus disease (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) constitutes a life-threatening condition, in particular for a subgroup of patients with underlying comorbidities. Besides age [1], the most relevant risk factors for severe COVID-19 course and SARS-CoV-2 infection-associated death include hypertension, cancer, respiratory disease, obesity and diabetes mellitus [2,3]. These conditions are associated with metabolic dysregulation and inflammation [4], compromised signalling by reactive oxygen species (ROS) [5], and may involve a disturbed trace element status [6,7]. Micronutrients may be of high relevance for reducing SARS-CoV-2 infection risk, supporting the immune system in combating the virus, and avoiding long-term adverse health issues from COVID-19 [10,11,12,13,14]
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