Serum zinc level independently predicts need for inpatient intubation among patients hospitalized with COVID‐19: A prospective observational study

Background The coronavirus disease 2019 (COVID‐19) pandemic caused significant morbidity and mortality. Further study of modifiable factors influencing COVID‐19 severity and outcomes continues to be necessary. Serum zinc levels may play a role in modulating COVID‐19 virus replication and consequently influence clinical outcomes. Methods This was a prospective observational study of adult patients hospitalized with COVID‐19 assessing the relationship between serum zinc levels and clinical outcomes. Serum zinc levels were measured within 7 days of admission. The primary outcome was the need for intubation at any time during inpatient stay. Secondary outcomes included hospital disposition and incidence of shock and acute kidney injury. Results Serum zinc levels could be obtained for 99 patients with COVID‐19. The 25 requiring intubation during hospitalization had a statistically significantly lower median (IQR) zinc concentration (51.6 µg/dl [46.3–62.3 µg/dl]) than those who did not (64.4 µg/dl [55.2–76.0 µg/dl]; P < 0.01). Patients requiring more respiratory support on hospital day 1, having acute kidney injury on hospital day 8, or requiring pressors on hospital days 1 or 8 also had significantly lower zinc levels. In multivariable analysis including other clinical factors known to influence outcomes in COVID‐19 disease, serum zinc level remained an independent predictor of the need for intubation (odds ratio 0.941, 95% CI 0.885–0.999; P = 0.048). Conclusion In multivariable analysis, lower serum zinc level was an independent predictor of inpatient intubation in COVID‐19, but further investigation of zinc supplementation to prevent or reduce severity in COVID‐19 infection is warranted before routine clinical use.