Zinc deficiency effect on clinical features of Coronavirus Disease 2019 patients: A scoping review

Moch Ikhsan  Juliansyah; Lisa Adhia Garina; Mirasari  Putri

doi:10.32889/actabioina.123

Moch Ikhsan Juliansyah Faculty of Medicine, Universitas Islam Bandung https://orcid.org/0000-0002-2875-2445
Lisa Adhia Garina Department of Pediatric, Faculty of Medicine, Universitas Islam Bandung, Bandung, 40116, Indonesia https://orcid.org/0000-0002-3545-0285
Mirasari Putri Department of Biochemistry, Nutrition, and Biomolecular, Faculty of Medicine, Universitas Islam Bandung, Bandung, 40116, Indonesia https://orcid.org/0000-0003-0520-1373

DOI: https://doi.org/10.32889/actabioina.123

Keywords: COVID-19, SARS-CoV-2, Zinc, Zinc deficiency, adjunct therapy, zinc, zinc deficiency

Abstract

COVID-19 was declared a pandemic in March 2020. Various therapeutic guidelines have been established for treating COVID-19, such as anti-inflammatory, antiviral therapies, and zinc supplementation. Zinc deficiency is thought to worsen the condition of patients with COVID-19 infection. However, the effect of zinc deficiency on COVID-19 patients has not been widely reported. In this scoping review, we aim to explore the impact of zinc deficiency on the clinical features of COVID-19 patients. A comprehensive search was conducted across the databases, including PubMed, ScienceDirect, Springer Link, ProQuest, and Google Scholar, using the keywords “Zinc” AND “(COVID-19 or SARS-CoV-2)”. A total of 2,458 articles published between 2019 and 2020 were screened following the PRISMA guidelines and subjected to critical appraisal. Three articles were included, focusing on the effect of zinc deficiency on the clinical features of COVID-19 patients. As of 2022, two articles reported worsening symptoms, one described an increased hospitalization duration, and one reported worsening treatment outcomes in the zinc deficiency group. This review concludes that zinc deficiency worsens symptoms, increases the duration of hospitalization, and leads to worse outcomes in COVID-19 patients.

References

Chen Q, Allot A, Lu Z. LitCovid: An open database of COVID-19 literature. Nucleic Acids Res. 2021;49: D1534-D1540. https://doi.org/10.1093/nar/gkaa952

Tsang HF, Chan LWC, Cho WCS, Yu ACS, Yim AKY, Chan AKC, et al. An update on COVID-19 pandemic: the epidemiology, pathogenesis, prevention and treatment strategies. Expert Rev Anti Infect Ther. 2021;19: 877-888. https://doi.org/10.1080/14787210.2021.1863146

Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta. 2020;508: 254-266.

https://doi.org/10.1016/j.cca.2020.05.044

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382: 1708-1720. https://doi.org/10.1056/NEJMoa2002032

Pfortmueller CA, Spinetti T, Urman RD, Luedi MM, Schefold JC. COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment - A narrative review. Best Pract Res Clin Anaesthesiol. 2021;35: 351-368. https://doi.org/10.1016/j.bpa.2020.12.011

Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020;2: 1069-1076. https://doi.org/10.1007/s42399-020-00363-4

Mukhlida HZ, Khairunnisa G, Rindu, Mukhlida HH, Mantrono MJ, Hartono RK, et al. Review of trial therapies and treatment for covid-19: Lessons for Indonesia. Kesmas. 2020;15: 99-104. https://doi.org/10.21109/kesmas.v15i2.3958

Samad N, Sodunke TE, Abubakar AR, Jahan I, Sharma P, Islam S, et al. The implications of zinc therapy in combating the covid-19 global pandemic. J Inflamm Res. 2021;14: 527-550. https://doi.org/10.2147/JIR.S295377

Santos HO. Therapeutic supplementation with zinc in the management of COVID-19-related diarrhea and ageusia/dysgeusia: Mechanisms and clues for a personalized dosage regimen. Nutr Rev. 2022;80: 1086-1093.https://doi.org/10.1093/nutrit/nuab054

Ayse Adin Selcuk. A Guide for Systematic Reviews: PRISMA. Turk Arch Otorhinolaryngol. 2019;57: 57-58. https://doi.org/10.5152/tao.2019.4058

Vogel-González M, Talló-Parra M, Herrera-Fernández V, Pérez-Vilaró G, Chillón M, Nogués X, et al. Low zinc levels at admission associates with poor clinical outcomes in sars-cov-2 infection. Nutrients. 2021;13: 1-13. https://doi.org/10.3390/nu13020562

Yasui Y, Yasui H, Suzuki K, Saitou T, Yamamoto Y, Ishizaka T, 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. https://doi.org/10.1016/j.ijid.2020.09.008

Jothimani D, Kailasam E, Danielraj S, Nallathambi B, Ramachandran H, Sekar P, et al. COVID-19: Poor outcomes in patients with zinc deficiency. Int J Infect Dis. 2020;100: 343-349. https://doi.org/10.1016/j.ijid.2020.09.014

Gonçalves TJM, Gonçalves SEAB, Guarnieri A, Risegato RC, Guimarães MP, de Freitas DC, 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: 186-191. https://doi.org/10.1002/ncp.10612

Hirano T, Murakami M, Fukada T, Nishida K, Yamasaki S, Suzuki T. Roles of Zinc and Zinc Signaling in Immunity: Zinc as an Intracellular Signaling Molecule. Adv Immunol. 2008;97: 149-176. https://doi.org/10.1016/S0065-2776(08)00003-5

Kido T, Ishiwata K, Suka M, Yanagisawa H. Inflammatory response under zinc deficiency is exacerbated by dysfunction of the T helper type 2 lymphocyte-M2 macrophage pathway. Immunology. 2019;156: 356-372. https://doi.org/10.1111/imm.13033

Prasad AS. Zinc in human health: Effect of zinc on immune cells. Mol Med. 2008;14: 353-357. https://doi.org/10.2119/2008-00033.Prasad

Rahman MT, Idid SZ. Can Zn Be a Critical Element in COVID-19 Treatment? Biol Trace Elem Res. 2021;199: 550-558. https://doi.org/10.1007/s12011-020-02194-9