Abstract
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.
Highlights
Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result in a systemic disease with a variety of outcomes, from no symptoms to severe and diverse pathologies, with pneumonia and acute respiratory distress symptom being the most common
zinc deficiency (ZD) is associated with higher levels of interleukin (IL)-1beta and tumor necrosis factor (TNF)-alfa [? ], as well as with altered activities of monocytes, neutrophils, and natural killer (NK) cells [? ? ? ]
COVID-19 was defined as a SARS-CoV-2 infection, confirmed by quantitative PCR performed in nasopharyngeal samples obtained by trained personnel at hospital admission, and by fulfilling clinical diagnostic criteria
Summary
Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result in a systemic disease with a variety of outcomes, from no symptoms to severe and diverse pathologies, with pneumonia and acute respiratory distress symptom being the most common. Zinc (Zn2+) is an essential trace element required for maintaining a variety of fundamental biological processes, due to its functions as a cofactor, signaling molecule, and structural element. ? ], as both the adaptive and the innate immunity, are affected by zinc levels. ]. In adaptive immunity, zinc affects T lymphocyte maturation, differentiation, and cytokine production. B cell activation and plasma cell differentiation depend on zinc signaling as well [? ]. Correspondingly, ZD results in increased susceptibility to inflammatory and infectious diseases, including acquired immune deficiency syndrome, measles, malaria, tuberculosis, and pneumonia [? ZD results in increased susceptibility to inflammatory and infectious diseases, including acquired immune deficiency syndrome, measles, malaria, tuberculosis, and pneumonia [? ]
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