A-324 The Clinical Significance of Zinc to Copper Ratio in the Early Management of COVID-19 and its Association with Disease Severity and Mortality

Background COVID-19, caused by the SARS-CoV-2 virus, can trigger a severe cascade of inflammatory responses in the body, called cytokine storm, leading to acute respiratory distress syndrome and other complications associated with COVID-19. Zinc (Zn) and copper (Cu) are among the most abundant trace elements in the human body and have various anti-inflammatory properties that affect the innate and adaptive immune systems. The objective of this study was to evaluate the association of Zn and Cu levels and Zn/Cu ratio with COVID-19 severity and mortality. Methods A total of 220 COVID-19 patients and 220 healthy age- and sex-matched controls were enrolled in this study. The COVID 19 diagnosis was confirmed by positive qRT-PCR and clinical criteria (signs, respiratory symptoms and chest CT findings). Clinicopathologic characteristics of COVID-19 patients and relevant laboratory parameters including WBC, platelet count, hemoglobin, albumin, blood glucose, kidney and liver function tests, lactate dehydrogenase, creatine phosphokinase, blood coagulation tests, D-dimer, iron, inflammatory marker CRP, electrolytes Na, K, Ca, P, Mg, Zn and Cu levels were assessed at hospital admission. Results COVID-19 patients had significantly lower serum Zn (p < 0.001), Zn/Cu ratio (p < 0.001) and higher Cu (p < 0.001) levels compared to controls. Interestingly, surviving patients had significantly higher serum Zn levels than non-surviving patients (p=0.01). The mean hospital stay for COVID-19 patients was 8.85 ± 7.37 days. Unfortunately, 41of the COVID-19 patients expired during the study. Furthermore, there was a negative correlation between Zn and Zn/Cu ratio with the inflammatory marker CRP (r = -0.17, p = 0.02; r = -0.26, p = 0.002, respectively). Our regression model revealed that serum Zn/Cu ratio was independently associated with COVID-19 mortality and severity. Conclusion We found that COVID-19 patients had lower serum Zn and Zn/Cu ratio. Also, low serum Zn/Cu ratio was associated with disease severity progression and mortality. Thus, evaluation of serum Zn and Cu levels and their ratio may be useful in the early management of COVID-19 patients.