新型冠状病毒SARS-CoV-2导致的低锌水平与急性呼吸窘迫综合征严重程度之间的关联
Association Between Low Zinc Levels and Severity of Acute Respiratory Distress Syndrome by New Coronavirus SARS-CoV-2.
作者信息
Gonçalves Thiago Jose Martins, Gonçalves Sandra Elisa Adami Batista, Guarnieri Andreia, Risegato Rodrigo Cristovão, Guimarães Maysa Penteado, de Freitas Daniella Cabral, Razuk-Filho Alvaro, Junior Pedro Batista Benedito, Parrillo Eduardo Fagundes
机构信息
Department of Nutrology and Clinical Nutrition, Sancta Maggiore Hospital, Prevent Senior Private Health Operator, São Paulo, Brazil.
出版信息
Nutr Clin Pract. 2021 Feb;36(1):186-191. doi: 10.1002/ncp.10612. Epub 2020 Dec 23.
BACKGROUND
We verify the prevalence of low zinc levels among critically ill patients infected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the intensive care unit (ICU) who required invasive mechanical ventilation, as well as its association with severity of acute respiratory distress syndrome (ARDS).
METHODS
This is an observational study composed of patients admitted to the ICU. Demographics, anthropometric data for calculating body mass index (BMI), and laboratory data were obtained at admission: blood count, ferritin, arterial blood gas, serum zinc levels, and C-reactive protein. Also, arterial oxygen tension (PaO ) divided by fractional inspired oxygen (FiO ) was calculated by the first arterial blood gas after intubation. A diagnosis of severe ARDS was determined if the PaO /FiO ratio was ≤100 mm Hg. Low zinc levels were established if zinc levels were <70 μg/dL.
RESULTS
A total of 269 patients met inclusion criteria; 51.3% were men; median age was 74 (66-81) years; 91.1% (245 of 269) were elderly. The median BMI was 30.1 (24.7-32.1) kg/m , with 59.9% (161 of 269) of patients having overweight and obesity. The prevalence of low zinc levels was 79.6% (214 of 269) and severe ARDS was 56.5% (152 of 269). There was an association of low zinc levels and severe ARDS (odds ratio [OR], 14.4; 95% CI, 6.2-33.5; P < .001), even after adjusting for baseline variables (OR, 15.4; 95% CI, 6.5-36.3; P < .001).
CONCLUSION
Critically ill patients infected by SARS-CoV-2 with severe ARDS have a high prevalence of low serum zinc levels.
背景
我们核实了重症监护病房（ICU）中因感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）而需要有创机械通气的重症患者低锌水平的患病率，以及其与急性呼吸窘迫综合征（ARDS）严重程度的关联。
方法
这是一项对入住ICU患者的观察性研究。收集患者入院时的人口统计学资料、用于计算体重指数（BMI）的人体测量数据以及实验室数据：血细胞计数、铁蛋白、动脉血气、血清锌水平和C反应蛋白。此外，插管后首次动脉血气计算动脉血氧分压（PaO）除以吸入氧分数（FiO）。如果PaO/FiO比值≤100 mmHg，则诊断为重度ARDS。如果锌水平<70 μg/dL，则确定为低锌水平。
结果
共有269例患者符合纳入标准；51.3%为男性；中位年龄为74（66 - 81）岁；91.1%（269例中的245例）为老年人。中位BMI为30.1（24.7 - 32.1）kg/m²，59.9%（269例中的161例）患者超重或肥胖。低锌水平的患病率为79.6%（269例中的214例），重度ARDS的患病率为56.5%（269例中的152例）。低锌水平与重度ARDS相关（比值比[OR]为14.4；95%置信区间[CI]为6.2 - 33.5；P <.001），即使在调整基线变量后（OR为15.4；95% CI为6.5 - 36.3；P <.001）。
结论
感染SARS-CoV-2且患有重度ARDS的重症患者血清锌水平低的患病率很高。
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