Systematic Review and Meta-Analysis: Effect of Zinc Levels in COVID-19 Patients on Their Clinical Severity
Keywords:
COVID-19, Zinc level, Severity, DeficiencyAbstract
Background: COVID-19 is a new type of Coronavirus that can cause ARDS and make it a worldwide pandemic. Treatment for COVID-19 is based on the clinical severity of COVID-19. Zinc has anti-inflammatory, antiviral, and antioxidant effects given as an adjuvant therapy for the treatment of COVID-19. Prolonged zinc deficiency is a risk factor for severe COVID-19.
Methods: This systematic review and meta-analysis study used 4 databases namely ScienceDirect, Cochrane Library, ProQuest, and PubMed. The keywords used are “Zinc” OR “Severity COVID-19” AND “Zinc Deficiency” OR “Mortality COVID-19” AND “Zinc” OR “Clinical Severity COVID-19” AND “Zinc Deficiency” OR “Clinical Severity COVID- 19”. The articles identified are articles that are relevant to the title of research, published internationally, accessed free of charge, published between 2019-2021, published in accredited journals
Results: Out of 8,330 article titles, 944 were excluded due to double counting in each database. A total of 7,371 articles were excluded because they did not match the title of the study, did not match the research method, used another language, did not match the year of publication. A total of 15 articles were included in the qualitative synthesis. Five studies were included in the meta-analysis. Three studies were analyzed with the results that the average zinc level of COVID-19 patients was not much different from that of healthy patients with a mean difference of 1.73 (95% CI -39.14-42.60). Two studies were analyzed with low zinc levels in patients with severe COVID-19 associated with the need to enter the intensive care unit with an OR of 3.62 The SARS-CoV-2 virus spreads through droplets that are expelled while coughing or sneezing. Conclusion: The average zinc level of COVID-19 patients is not different from that of healthy patients, but low zinc levels in patients with severe COVID-19 are associated with the need to enter the intensive care unit.
References
Kumar A, Kubota Y, Chernov M, Kasuya H. Potential Role Of Zinc Supplementation In Prophylaxis And Treatment Of COVID-19. 2020;(January).
Rashedi J, Poor BM, Asgharzadeh V, et al. Risk factors for covid-19. Infez Med. 2020;28(4):469-474.
Tedjaatmadja C. Peran Suplementasi Zinc Pada Infeksi COVID-19. 2021;02(02):456-468.
COVID-19 STP. Peta Sebaran | Covid19.go.id.
WHO. Therapeutics and COVID-19. 2021;(September).
Luo X, Liao Q, Shen Y, Li H, Cheng L. Vitamin D Deficiency Is Associated with COVID-19 Incidence and Disease Severity in Chinese People [corrected]. J Nutr. 2021;151(1):98-103. doi:10.1093/JN/NXAA332
Adetokunbo A, Temitayo O, Ajibade O, et al. Potential health benefits of zinc supplementation for the management of COVID-19 pandemic. 2021;(December 2020):1-12. doi:10.1111/jfbc.13604
Pal A, Squitti R, Picozza M, et al. Zinc and COVID-19: Basis of Current Clinical Trials. Biol Trace Elem Res. Published online 2020. doi:10.1007/s12011-020-02437-9
Wessels I, Rolles B, Rink L. The Potential Impact of Zinc Supplementation on COVID-19 Pathogenesis. Front Immunol. 2020;11. doi:10.3389/fimmu.2020.01712
Scott A Read. Peran Seng dalam Kekebalan Antiviral. Univ Sydney Westmead Hosp Westmead, New South Wales, Aust. Published online 2019:696-710.
Dubourg G, Lagier JC, Brouqui P, et al. Low blood zinc concentrations in patients with poor clinical outcome during SARS-CoV-2 infection: is there a need to supplement with zinc COVID-19 patients? J Microbiol Immunol Infect. 2021;(xxxx):0-3. doi:10.1016/j.jmii.2021.01.012
Jothimani D, Kailasam E, Danielraj S, et al. COVID-19: Poor outcomes in patients with zinc deficiency. Int J Infect Dis. 2020;100:343-349. doi:10.1016/j.ijid.2020.09.014
Yasui Y. Analysis of the predictive factors for a critical illness of COVID-19 during treatment - relationship between serum zinc level and critical illness of COVID-19. 2020;(January).
Gonçalves TJM, Gonçalves SEAB, Guarnieri A, et al. Association Between Low Zinc Levels and Severity of Acute Respiratory Distress Syndrome by New Coronavirus SARS-CoV-2. Nutr Clin Pract. 2021;36(1):186-191. doi:10.1002/ncp.10612
Heller RA, Sun Q, Hackler J, et al. Prediction of survival odds in COVID-19 by zinc, age and selenoprotein P as composite biomarker. Redox Biol. 2021;38(August 2020):101764. doi:10.1016/j.redox.2020.101764
Taghi M, D SBM, Ph D, Abdollahi A. The association between serum levels of micronutrients and the severity in patients with COVID-19. 2020;(January).
Razeghi Jahromi S, Moradi Tabriz H, Togha M, et al. The correlation between serum selenium, zinc, and COVID-19 severity: an observational study. BMC Infect Dis. 2021;21(1):1-9. doi:10.1186/s12879-021-06617-3
Shakeri H, Azimian A, Ghasemzadeh-Moghaddam H, et al. Evaluation of the relationship between serum levels of zinc, vitamin B12, vitamin D, and clinical outcomes in patients with COVID-19. J Med Virol. Published online 2021. doi:10.1002/JMV.27277
Hosseini SJ, Moradi B, Firouzian AA, Ildarabadi E, Abedi A, Firooz M. Comparing Serum Levels of Vitamin D and Zinc in Novel Coronavirus – Infected Patients and Healthy Individuals in. 2021;29(6):390-394.
Du Laing G, Petrovic M, Lachat C, et al. Course and survival of covid-19 patients with comorbidities in relation to the trace element status at hospital admission. Nutrients. 2021;13(10):1-16. doi:10.3390/nu13103304
Fromonot J, Gu eant-Rodriguez R-M, A, et al. Hypozincemia in the early stage of COVID-19 is associated with an increased risk of severe COVID-19. 2020;(January).
Suzuki K, Ashtary-larky D, Maghsoudi F, Naghashpour M. The Association between Vitamin D and Zinc Status and the with SARS-CoV-2 and Potentially Non-Infected Participants : 2021;2019.
Tomasa-Irriguible TM, Bielsa-Berrocal L, Bordejé-Laguna L, et al. Low levels of few micronutrients may impact COVID-19 disease progression: An observational study on the first wave. Metabolites. 2021;11(9). doi:10.3390/metabo11090565
Pour OB, Yahyavi Y, Karimi A, Khamaneh AM. Serum Trace Elements Levels and Clinical Outcomes Among Irian COVID-19 Patients. 2020;(January).
Verschelden G, Noeparast M, Noparast M, Michel C, Goyvaerts C. Plasma Zinc Status and Hyperinflammatory syndrome in Hospitalized COVID-19 patients: An Observational Study. 2020;(January).
Shahvali A, Azam K, Azam J. Serum Vitamin D, Calcium, and Zinc Levels in Patients With COVID-19. 2020;(January).
Yasui Y, Yasui H, Suzuki K, et al. Analysis of the predictive factors for a critical illness of COVID-19 during treatment - relationship between serum zinc level and critical illness of COVID-19 −. Int J Infect Dis. 2020;100:230-236. doi:10.1016/j.ijid.2020.09.008
Calder PC, Carr AC, Gombart AF, Eggersdorfer M. “comment on: Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. nutrients 2020, 12, 1181.” Nutrients. 2020;12(8):1-3. doi:10.3390/nu12082326
Alamir OF, Oladele RO, Ibe C. Nutritional immunity: targeting fungal zinc homeostasis. Heliyon. 2021;7(8):e07805. doi:10.1016/j.heliyon.2021.e07805
Lonergan ZR, Skaar EP. Nutrient Zinc at the Host–Pathogen Interface. Trends Biochem Sci. 2019;44(12):1041-1056. doi:10.1016/j.tibs.2019.06.010
Hiffler L, Rakotoambinina B. Selenium and RNA Virus Interactions: Potential Implications for SARS-CoV-2 Infection (COVID-19). Front Nutr. 2020;7(September):1-10. doi:10.3389/fnut.2020.00164
WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected.
Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020;8(5):506-517. doi:10.1016/S2213-2600(20)30161-2
Zabetakis I, Lordan R, Norton C, Tsoupras A. COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation. Nutrients. 2020;12(5). doi:10.3390/NU12051466
Guan WJ et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):640. doi:10.1183/13993003.00547-2020
Hajjar LA, Costa IBS da S, Rizk SI, et al. Intensive care management of patients with COVID-19: a practical approach. Ann Intensive Care. 2021;11(1). doi:10.1186/s13613-021-00820-w
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