4e761ddeed4ade6d7ddb2c8453950db0 pmc_33572045.pdf 7851d4bb94530bbb4a0ee4ece532a8a812878a24 pmc_33572045.pdf b2b1606dc9ba2ea9ebfa0a58b94aa05e93ebd061aa63176cf567e6db8f2a0dad pmc_33572045.pdf Title: Low Zinc Levels at Admission Associates with Poor Clinical Outcomes in SARS-CoV-2 Infection Subject: Background: Zinc is an essential micronutrient that impacts host–pathogen interplay at infection. Zinc balances immune responses, and also has a proven direct antiviral action against some viruses. Importantly, zinc deficiency (ZD) is a common condition in elderly and individuals with chronic diseases, two groups with an increased risk for severe severe coronavirus disease 2019 (COVID-19) outcomes. We hypothesize that serum zinc content (SZC) influences COVID-19 disease progression, and thus might represent a useful biomarker. Methods: We ran an observational cohort study with 249 COVID-19 patients admitted in Hospital del Mar. We have studied COVID-19 severity and progression attending to SZC at admission. In parallel, we have studied severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) replication in the Vero E6 cell line modifying zinc concentrations. Findings: Our study demonstrates a correlation between serum zinc levels and COVID-19 outcome. Serum zinc levels lower than 50 g/dL at admission correlated with worse clinical presentation, longer time to reach stability, and higher mortality. Our in vitro results indicate that low zinc levels favor viral expansion in SARS-CoV-2 infected cells. Interpretation: Low SZC is a risk factor that determines COVID-19 outcome. We encourage performing randomized clinical trials to study zinc supplementation as potential prophylaxis and treatment with people at risk of zinc deficiency. Keywords: SARS-CoV-2; zinc; clinical outcomes Author: Marina Vogel-González, Marc Talló-Parra, Víctor Herrera-Fernández, Gemma Pérez-Vilaró, Miguel Chillón, Xavier Nogués, Silvia Gómez-Zorrilla, Inmaculada López-Montesinos, Isabel Arnau-Barrés, Maria Luisa Sorli-Redó, Juan Pablo Horcajada, Natalia García-Giralt, Julio Pascual, Juana Díez, Rubén Vicente and Robert Güerri-Fernández Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Feb 9 04:42:40 2021 CET ModDate: Tue Feb 9 04:50:18 2021 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 7254695 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HVENEK+VnURWPalladioL Type 1 Custom yes yes no 10 0 XSVVIN+EURM10 Type 1 Builtin yes yes no 15 0 XVOKGX+URWPalladioL-Ital Type 1 Custom yes yes no 19 0 AJPHON+URWPalladioL-Bold Type 1 Custom yes yes no 24 0 DYLASC+URWPalladioL-Roma Type 1 Custom yes yes no 28 0 JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 40 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 62 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 66 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 70 0 JDCKWC+CMSY10 Type 1 Builtin yes yes no 82 0 XIRVNA+EURB10 Type 1 Builtin yes yes no 95 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 99 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2021-05-28 02:57:53 CEST RepresentationInformation: pmc_33572045.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2021-03-29 03:37:51 CEST Size: 7254695 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 215 FreeObjects: 7 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Info: Title: Low Zinc Levels at Admission Associates with Poor Clinical Outcomes in SARS-CoV-2 Infection Author: Marina Vogel-González, Marc Talló-Parra, Víctor Herrera-Fernández, Gemma Pérez-Vilaró, Miguel Chillón, Xavier Nogués, Silvia Gómez-Zorrilla, Inmaculada López-Montesinos, Isabel Arnau-Barrés, Maria Luisa Sorli-Redó, Juan Pablo Horcajada, Natalia García-Giralt, Julio Pascual, Juana Díez, Rubén Vicente and Robert Güerri-Fernández Subject: Background: Zinc is an essential micronutrient that impacts host pathogen interplay at infection. Zinc balances immune responses, and also has a proven direct antiviral action against some viruses. Importantly, zinc deficiency (ZD) is a common condition in elderly and individuals with chronic diseases, two groups with an increased risk for severe severe coronavirus disease 2019 (COVID-19) outcomes. We hypothesize that serum zinc content (SZC) influences COVID-19 disease progression, and thus might represent a useful biomarker. Methods: We ran an observational cohort study with 249 COVID-19 patients admitted in Hospital del Mar. We have studied COVID-19 severity and progression attending to SZC at admission. In parallel, we have studied severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) replication in the Vero E6 cell line modifying zinc concentrations. Findings: Our study demonstrates a correlation between serum zinc levels and COVID-19 outcome. Serum zinc levels lower than 50 g/dL at admission correlated with worse clinical presentation, longer time to reach stability, and higher mortality. Our in vitro results indicate that low zinc levels favor viral expansion in SARS-CoV-2 infected cells. Interpretation: Low SZC is a risk factor that determines COVID-19 outcome. We encourage performing randomized clinical trials to study zinc supplementation as potential prophylaxis and treatment with people at risk of zinc deficiency. 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