Investigation of zinc levels in patients with COVID-19

Öz

Objective: Zinc (Zn) is an important trace element known to play a role in defense against viral infections as well as its immune response enhancing effect. In this study, it was aimed to determine Zn levels in COVID-19 cases followed in our clinic and to examine its relationship with routine laboratory parameters and disease severity. Method: One hundred thirty-five COVID-19 patients and 26 healthy individuals were included in the study. Serum Zn levels were measured by colorimetric method. In addition, creatinine, ALT, AST CK, LDH, ferritin, CRP, D-dimer and fibrinogen levels were evaluated. Results: Serum Zn levels in all patient groups compared to the control group; it was found to be statistically significantly lower in the moderate, severe and critical patient groups compared to the mild patient group. In addition, while Zn levels showed a weak negative and significant correlation with creatinine, ALT, AST, CK, leukocyte levels, they showed a significant, moderate and negative correlation with age, CRP, ferritin, D-dimer and fibrinogen levels. Conclusion: Serum Zn levels are statistically significantly lower in COVID-19 patients than in healthy individuals. Although there was no clear relationship between the severity of the disease and serum Zn levels in COVID-19 cases, it was observed that there was a significant relationship between the biochemical and inflammatory markers associated with the severity of the disease and serum Zn levels.

Anahtar Kelimeler

• Zinc
• Coronavirus Disease
• İnflammation

COVID-19 hastalarında çinko düzeylerinin incelenmesi

Öz

Amaç: Çinko (Zn), immün yanıtı güçlendirici etkisinin yanı sıra viral enfeksiyonlara karşı savunmada da rol oynadığı bilinen önemli bir eser elementtir. Bu çalışma ile kliniğimizde izlenen COVID-19 olgularında Zn düzeylerinin belirlenerek, rutin laboratuvar parametreleri ve hastalık şiddeti ile olan ilişkisinin irdelenmesi amaçlanmıştır. Yöntem: Çalışmaya 135 COVID-19 hastası ile 26 sağlıklı birey dahil edilmiştir. Serum Zn, düzeyleri kolorimetrik yöntem ile ölçülmüştür. Ayrıca kreatinin, ALT, AST CK, LDH, ferritin, CRP, D-dimer ve fibrinojen düzeyleri değerlendirilmiştir. Bulgular: Serum Zn düzeyleri tüm hasta gruplarında kontrol grubuna kıyasla; orta, ağır ve kritik hasta gruplarında ise hafif hasta grubuna kıyasla istatistiksel olarak anlamlı düzeyde düşük bulunmuştur. Ayrıca Zn düzeyleri kreatinin, ALT, AST, CK, lökosit düzeyleri ile zayıf negatif ve anlamlı bir korelasyon gösterirken, yaş, CRP, ferritin, D-dimer ve fibrinojen düzeyleri ile anlamlı, orta derecede ve negatif yönde bir korelasyon göstermiştir. Sonuç: Serum Zn düzeyleri COVID-19 hastalarında sağlıklı bireylere göre istatistiksel olarak anlamlı oranda daha düşüktür. COVID-19 olgularında hastalık şiddeti ile serum Zn düzeyleri arasında net bir ilişki bulunamamış olsa da hastalık şiddeti ile ilişkili biyokimyasal ve inflamatuar markırlar ile serum Zn düzeyleri arasında anlamlı bir ilişki olduğu görülmüştür.

Anahtar Kelimeler

• Koronavirüs Hastalığı
• Çinko
• İnflamasyon

Kaynakça

1. Dogan S, Bal T, Cabalak M, Dikmen N, Yaqoobi H, Ozcan O. Oxidative stress index can be a new marker related to disease severity in COVID-19. Turkish Journal of Biochemistry. Pre-published online by De Gruyter August 9, 2021. 000010151520210013. https://doi.org/10.1515/tjb-2021-0013
2. Pal A, Squitti R, Picozza M, Pawar A, Rongioletti M, Dutta AK, Sahoo S, Goswami K, Sharma P, Prasad R. Zinc and COVID-19: Basis of Current Clinical Trials. Biol Trace Elem Res. 2021 Aug;199(8):2882-2892. doi: 10.1007/s12011-020-02437-9. Epub 2020 Oct 22. PMID: 33094446; PMCID: PMC7580816.
3. Tamer A, Nalbant A. Nutrition and immun system . Sakarya Med J 2021, 11(2):458-466, doi:10.31832/smj.896467
4. Prasad AS. Clinical, immunological, anti-inflammatory and antioxidant roles of zinc. Exp Gerontol. 2008 May;43(5):370-7. doi: 10.1016/j.exger.2007.10.013. Epub 2007 Nov 1. PMID: 18054190
5. Gungor EO, Yaldız N, Ozbek SC. Micronutrients supporting immune system: Review for COVID-19. Journal of Health Science Yuksek Ihtısas University. 2020;1:53-56.
6. Saatci E. Newly developed diagnostic methods for SARS-CoV-2 detection, Turkish Journal of Biochemistry 2020;45(5),465-474.
7. Elham AS, Azam K, Azam J, Mostafa L, Nasrin B, Marzieh N. Serum vitamin D, calcium, and zinc levels in patients with COVID-19. Clin Nutr ESPEN. 2021 Jun;43:276-282. doi: 10.1016/j.clnesp.2021.03.040. Epub 2021 Apr 18. PMID: 34024527; PMCID: PMC8053215.
8. Heller RA, Sun Q, Hackler J, Seelig J, Seibert L, Cherkezov A, Minich WB, Seemann P, Diegmann J, Pilz M, Bachmann M, Ranjbar A, Moghaddam A, Schomburg L. Prediction of survival odds in COVID-19 by zinc, age and selenoprotein P as composite biomarker. Redox Biol. 2021 Jan;38:101764. doi: 10.1016/j.redox.2020.101764. Epub 2020 Oct 20. PMID: 33126054; PMCID: PMC7574778.

9. Skalny AV, Timashev PS, Aschner M, Aaseth J, Chernova LN, Belyaev VE, Grabeklis AR, Notova SV, Lobinski R, Tsatsakis A, Svistunov AA, Fomin VV, Tinkov AA, Glybochko PV. Serum Zinc, Copper, and Other Biometals Are Associated with COVID-19 Severity Markers. Metabolites. 2021 Apr 15;11(4):244. doi: 10.3390/metabo11040244. PMID: 33920813; PMCID: PMC8071197.
10. Yasui Y, Yasui H, Suzuki K, Saitou T, Yamamoto Y, Ishizaka T, Nishida K, Yoshihara S, Gohma I, Ogawa 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. Int J Infect Dis. 2020 Nov;100:230-236. doi: 10.1016/j.ijid.2020.09.008. Epub 2020 Sep 7. PMID: 32911042; PMCID: PMC7476566.
11. Sönmez D, Özcan O. COVID-19 patogenezinde oksidatif stresin rolü. Yücel D, editör. COVID-19 Pandemisinde Tıbbi Biyokimyanın Artan Rolü. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.68-74.
12. Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med 2020;8(6):e46-e47.
13. Jomova K, Valko M. Advances in metal-induced oxidative stress and human disease. Toxicology. 2011 May 10;283(2-3):65-87. doi: 10.1016/j.tox.2011.03.001. Epub 2011 Mar 23. PMID: 21414382.
14. Cabral M, Kuxhaus O, Eichelmann F, Kopp JF, Alker W, Hackler J, Kipp AP, Schwerdtle T, Haase H, Schomburg L, Schulze MB. Trace element profile and incidence of type 2 diabetes, cardiovascular disease and colorectal cancer: results from the EPIC-Potsdam cohort study. Eur J Nutr. 2021 Sep;60(6):3267-3278. doi: 10.1007/s00394-021-02494-3. Epub 2021 Feb 15. PMID: 33590281.
15. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, Salazar-Mather TP, Dumenco L, Savaria MC, Aung SN, Flanigan T, Michelow IC. Predictors of COVID-19 severity: A literature review. Rev Med Virol. 2021 Jan;31(1):1-10. doi: 10.1002/rmv.2146. Epub 2020 Jul 30. PMID: 32845042; PMCID: PMC7855377.
16. Okuyan HM, Dogan S, Bal T, Çabalak M. Beclin-1, an autophagy-related protein, is associated with the disease severity of COVID-19. Life Sci. 2021 Aug 1;278:119596. doi: 10.1016/j.lfs.2021.119596. Epub 2021 May 10. PMID: 33984360; PMCID: PMC8107047.