Abstract
SARS-CoV-2 infections underlie the current coronavirus disease (COVID-19) pandemic and are causative for a high death toll particularly among elderly subjects and those with comorbidities. Selenium (Se) is an essential trace element of high importance for human health and particularly for a well-balanced immune response. The mortality risk from a severe disease like sepsis or polytrauma is inversely related to Se status. We hypothesized that this relation also applies to COVID-19. Serum samples (n = 166) from COVID-19 patients (n = 33) were collected consecutively and analyzed for total Se by X-ray fluorescence and selenoprotein P (SELENOP) by a validated ELISA. Both biomarkers showed the expected strong correlation (r = 0.7758, p < 0.001), pointing to an insufficient Se availability for optimal selenoprotein expression. In comparison with reference data from a European cross-sectional analysis (EPIC, n = 1915), the patients showed a pronounced deficit in total serum Se (mean ± SD, 50.8 ± 15.7 vs. 84.4 ± 23.4 µg/L) and SELENOP (3.0 ± 1.4 vs. 4.3 ± 1.0 mg/L) concentrations. A Se status below the 2.5th percentile of the reference population, i.e., [Se] < 45.7 µg/L and [SELENOP] < 2.56 mg/L, was present in 43.4% and 39.2% of COVID samples, respectively. The Se status was significantly higher in samples from surviving COVID patients as compared with non-survivors (Se; 53.3 ± 16.2 vs. 40.8 ± 8.1 µg/L, SELENOP; 3.3 ± 1.3 vs. 2.1 ± 0.9 mg/L), recovering with time in survivors while remaining low or even declining in non-survivors. We conclude that Se status analysis in COVID patients provides diagnostic information. However, causality remains unknown due to the observational nature of this study. Nevertheless, the findings strengthen the notion of a relevant role of Se for COVID convalescence and support the discussion on adjuvant Se supplementation in severely diseased and Se-deficient patients.
Highlights
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections underlie the current coronavirus disease (COVID-19) pandemic and are causative for an increasingly high death toll among elderly subjects and those who have severe comorbidities, e.g., chronic obstructive pulmonary disease, hypertension, diabetes, cancer, or a combination thereof [1,2]
At present, the data base is very small in relation to these micronutrients, and it is unknown whether certain vitamins or trace elements are deficient in patients with COVID-19, and whether the concentrations are related to disease severity or mortality risk
A comparison of the median values and inter quartile ranges (IQR) of the samples from the COVID-19 patients who did not survive in relation to the reference cohort of healthy adult European subjects indicates that the groups differ strongly, i.e., the IQR do not overlap
Summary
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections underlie the current coronavirus disease (COVID-19) pandemic and are causative for an increasingly high death toll among elderly subjects and those who have severe comorbidities, e.g., chronic obstructive pulmonary disease, hypertension, diabetes, cancer, or a combination thereof [1,2]. The attempts at controlling the inflammation by immunosuppressive treatment using, e.g., high dosages of corticosteroids have shown promising effects in reducing the rate of fatal disease course among the severely diseased COVID patients on mechanical ventilation (medRxiv 2020.06.22.20137273), causing a surge in dexamethasone demand [4]. This treatment success is reminiscent of the positive reports on dexamethasone being capable of positively affecting the course of severe acute respiratory distress syndrome [5], or of reducing the mortality rate in severely diseased and delirious patients from typhoid fever [6]. We hypothesized that severe Se deficiency is prevalent among the patients and associates with poor survival odds in COVID-19
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