Persistent low serum zinc is associated with recurrent sepsis in critically ill patients - A pilot study.

Janine Hoeger,Gernot Marx,Thorben Beeker,Tim-Philipp Simon,Tobias Schuerholz,Hajo Haase,Chiara Lazzeri

doi:10.1371/journal.pone.0176069

Abstract

Zinc is an essential trace element for both pathogens and hosts. Hypozincemia is a well known phenomenon in sepsis patients and represents the innate immune systems attempt to deprive pathogens of zinc. However little is known about course, restitution and prognostic value of serum zinc levels in sepsis patients. We performed a prospective observational single-center study set in a tertiary care university hospital intensive care unit. Serum zinc levels were singularly measured of healthy controls and sequentially of surgical sepsis patients and surgical patients over a 8-day period. Throughout the study period, we report significantly decreased serum zinc levels in surgical and surgical sepsis patients compared to healthy controls. Lower serum zinc levels in surgical sepsis patients were associated with a higher susceptibility to a recurrent sepsis episode. Furthermore, surgical sepsis patients with a higher number of organ dysfunctions and increased in-hospital mortality at day 28 and 90 showed lower serum zinc levels at admission. We report serum zinc levels as a promising biomarker in the diagnosis and evaluation of sepsis patients. However, it is still unclear whether these findings are caused by an over-amplified redistribution of zinc during acute-phase response, or whether the critically ill patients were zinc deficient before sepsis.

Highlights

Sepsis is a severe condition and the most common cause of death in critically ill patients [1]
Besides the high mortality in the acute phase of sepsis there is growing evidence that survivors of sepsis are more susceptible to infections, resulting in an increased re-hospitalization rate, higher morbidity and consecutively higher mortality [4]
Mortality and Sequential Organ Failure Assessment (SOFA) Score were highest in septic shock patients (Table 1)

Summary

Introduction

Sepsis is a severe condition and the most common cause of death in critically ill patients [1]. As implemented by the Surviving Sepsis Campaign [2], time to adequate therapy is the major factor in the acute management of this condition. Mortality rates of sepsis patients increase for each and every hour without antimicrobial therapy [3]. Besides the high mortality in the acute phase of sepsis there is growing evidence that survivors of sepsis are more susceptible to infections, resulting in an increased re-hospitalization rate, higher morbidity and consecutively higher mortality [4].

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Discussion

Conclusion