There is an association between low zinc levels and the severity of acute respiratory distress syndrome (ARDS) in COVID-19 people. Artificial nutrition such as parenteral nutrition (PN) or enteral nutrition may be needed to avoid malnutrition. Low serum zinc and copper levels have been observed among ICU patients, whereas patients with high serum concentrations have significantly low mortality rates. A retrospective study was conducted on thirty-five COVID-19 patients on PN for 14 days, of which 27 patients were admitted in ICU and 8 patients were in respiratory intermediate care. Most of the patients were males, less than half had hypertension, and less than a third had obesity or type 2 DM.
Only one patient had zinc deficiency. Serum samples for zinc and copper were collected at three time points: at the start of PN, between 3 and 7 d after, and at the end of PN. Serum biochemical variables, serum copper, serum zinc, C-reactive protein, procalcitonin, D-dimer, IL-6, and IL-12 were analyzed. On follow-up, there was an increase in alanine aminotransferase, γ-glutamyl transpeptidase, and D dimer. Serum IL-6, IL-12, total proteins, and albumin remained stable. During PN administration, serum zinc concentrations increased from 98.8±22.8 to 114.1±23.3 μg/dL, whereas serum copper concentrations showed no changes till the end of the study.
ICU patients had longer hospital stays compared to those in intermediate care with similar serum zinc levels. Supplementation of zinc in PN increases the serum zinc concentration in severe COVID-19 patients which reduces the total duration of stay in hospital. Also, serum copper concentration was lower in ICU patients and was not associated with prognosis. Mortality was not associated with supplemental zinc or with serum zinc or copper concentrations at any time of the study. Thus, supplementation of PN with zinc could be considered as a prophylactic treatment in COVID-19 patients. Further clinical trials are needed to evaluate the role of zinc and copper supplementation in COVID-19 patients.
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