Acta Scientific Nutritional Health (ASNH)(ISSN: 2582-1423)

Research Article Volume 7 Issue 3

Mortality and Clinical Outcomes of Hospitalized COVID-19 Patients is Associated with Serum Concentrations of Selenium and Vitamin D

Reihane Taheri1,6, Hossein Faramarzi2,3, Maryam Ekramzadeh1*, Hadi Raeisi Shahraki4, Zahra Negarande5 and Siavash Babajafari1,5

1Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3Health Behavior Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
5Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
6Metabolic and Cardiovascular Diseases Laboratory, Division of Human Nutrition, University of Alberta, Edmonton

*Corresponding Author: Maryam Ekramzadeh, Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.

Received: February 16, 2023; Published: March 01, 2023

Abstract

Background: Coronavirus disease (COVID-19) has imposed serious effects on public health. The main defender against this viral inflammatory disease is the body’s immune system. Selenium and vitamin D as anti-inflammatory, immune-enhancing micronutrients could be beneficial in alleviating the worst outcomes of COVID-19.

Methods: One hundred hospitalized COVID-19 patients with saturation of oxygen (SpO2) < 94 were assessed. In the first day of admission to the hospital, serum selenium and 25-hydroxy vitamin D concentrations were measured. Other clinical outcomes, including lung involvement, length of hospital stay (LOS), C-reactive protein (CRP), SpO2, intubation, and gastrointestinal and neural symptoms were extracted from each patient’s medical record. Twenty-four-hour food recall was taken to evaluate the food intake of patients.

Results: Fifty-six percent of patients were 25-hydroxy vitamin D deficient, and 2 percent were selenium deficient. After adjusting for confounding variables, serum selenium was negatively associated with mortality (coefficient: -0.16, p-value: 0.01) and both selenium (coefficient: -0.10, p-value: 0.01) and 25-hydroxy vitamin D (coefficient: -0.11, p-value: 0.004) showed inverse correlation with LOS.

Conclusion: There is an inverse association between serum concentrations of selenium and 25-hydroxy vitamin D with adverse clinical outcomes and mortality of patients with severe COVID-19. Higher concentrations of selenium were associated with increased SpO2 and decreased LOS and risk of death. Although higher concentrations of 25-hydroxy vitamin D were associated with reduced LOS and percentage of lung involvement, no association was found regarding mortality

Keywords: Selenium; Vitamin D; COVID-19; Lung Involvement; Mortality

References

  1. Hu B., et al. “The cytokine storm and COVID-19”. Journal of Medical Virology1 (2021): 250-256.
  2. Ludwig S and Zarbock A. “Coronaviruses and SARS-CoV-2: A Brief Overview”. Anesthesia and Analgesia1 (2020): 93-96.
  3. Almutairi N and Schwartz RA. “COVID-19 with dermatologic manifestations and implications: An unfolding conundrum”. Dermatologic Therapy5 (2020): e13544.
  4. Banerjee D and Rai M. “Social isolation in Covid-19: The impact of loneliness”. The International Journal of Social Psychiatry6 (2020): 525-527.
  5. Chang WT., et al. “Cardiac Involvement of COVID-19: A Comprehensive Review”. The American Journal of the Medical Sciences1 (2021): 14-22.
  6. Daneshgaran G., et al. “Cutaneous Manifestations of COVID-19: An Evidence-Based Review”. American Journal of Clinical Dermatology5 (2020): 627-639.
  7. Dani M., et al. “Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies”. Clinical Medicine (London, England)1 (2021): e63-e67.
  8. Flanagan EW., et al. “The Impact of COVID-19 Stay-At-Home Orders on Health Behaviors in Adults”. Obesity (Silver Spring, Md)2 (2021): 438-445.
  9. Hawkins M., et al. “A rapid review of the pathoetiology, presentation, and management of delirium in adults with COVID-19”. Journal of Psychosomatic Research 141 (2021): 110350.
  10. Hunt RH., et al. “COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist”. Digestive Diseases (Basel, Switzerland)2 (2021): 119-139.
  11. Jakovljevic M., et al. “COVID-19 Pandemia and Public and Global Mental Health from the Perspective of Global Health Securit”. Psychiatria Danubina1 (2020): 6-14.
  12. Li Y and Xiao SY. “Hepatic involvement in COVID-19 patients: Pathology, pathogenesis, and clinical implications”. Journal of Medical Virology9 (2020): 1491-1494.
  13. Post A., et al. “Kidney Infarction in Patients With COVID-19”. American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation3 (2020): 431-435.
  14. Xiong J., et al. “Impact of COVID-19 pandemic on mental health in the general population: A systematic review”. Journal of Affective Disorders 277 (2020): 55-64.
  15. Nogueira-de-Almeida CA., et al. “COVID-19 and obesity in childhood and adolescence: a clinical review”. Jornal de Pediatria 5 (2020): 546-558.
  16. Asselah T., et al. “COVID-19: Discovery, diagnostics and drug development”. Journal of Hepatology 1 (2021): 168-184.
  17. Cheng VC., et al. “The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2”. The Journal of Infection1 (2020): 107-114.
  18. Lotfi M., et al. “COVID-19: Transmission, prevention, and potential therapeutic opportunities”. Clinica Chimica Acta; International Journal of Clinical Chemistry 508 (2020): 254-266.
  19. Przekwas A and Chen Z. “Washing hands and the face may reduce COVID-19 infection”. Medical Hypotheses 144 (2020): 110261.
  20. Noh JY., et al. “SARS-CoV-2 mutations, vaccines, and immunity: implication of variants of concern”. Signal Transduction and Targeted Therapy1 (2021): 203.
  21. Iddir M., et al. “Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis”. Nutrients 6 (2020): 1562.
  22. Pecora F., et al. “The Role of Micronutrients in Support of the Immune Response against Viral Infections". Nutrients10 (2020): 3198.
  23. Calder PC., et al. “Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections”. Nutrients4 (2020): 12.
  24. Chandra RK. “Nutrition and the immune system: an introduction”. The American Journal of Clinical Nutrition 2 (1997): 460s-463s.
  25. Childs CE., et al. “Diet and Immune Function”. Nutrients8 (2019).
  26. Gombart AF., et al. “A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection”. Nutrients 12 (2020).
  27. Junaid K., et al. “Effective Immune Functions of Micronutrients against SARS-CoV-2”. Nutrients 10 (2020): 2992.
  28. Vaughn AR., et al. “Micronutrients in Atopic Dermatitis: A Systematic Review”. Journal of Alternative and Complementary Medicine (New York, NY) 25 (2019): 567-577.
  29. Wintergerst ES., et al. “Contribution of selected vitamins and trace elements to immune function”. Annals of Nutrition and Metabolism4 (2007): 301-323.
  30. Bae M and Kim H. “Mini-Review on the Roles of Vitamin C, Vitamin D, and Selenium in the Immune System against COVID-19”. Molecules22 (2020): 5346.
  31. Shakoor H., et al. “Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19?” Maturitas 143 (2021): 1-9.
  32. Zabetakis I., et al. “COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation”. Nutrients5 (2020).
  33. Ye Q., et al. “The pathogenesis and treatment of the `Cytokine Storm' in COVID-19”. The Journal of Infection 6 (2020): 607-613.
  34. Ragab D., et al. “The COVID-19 Cytokine Storm; What We Know So Far”. Frontiers in Immunology 11 (2020): 1446.
  35. Soy M., et al. “Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment”. Clinical Rheumatology7 (2020): 2085-2094.
  36. Jiang Q. “Natural forms of vitamin E: metabolism, antioxidant, and anti-inflammatory activities and their role in disease prevention and therapy”. Free Radical Biology and Medicine 72 (2014): 76-90.
  37. Mrityunjaya M., et al. “Immune-Boosting, Antioxidant and Anti-inflammatory Food Supplements Targeting Pathogenesis of COVID-19”. Frontiers in Immunology 11 (2020): 570122.
  38. Notz Q., et al. “Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS”. Nutrients 6 (2021): 2113.
  39. Annweiler C., et al. “Vitamin D supplementation prior to or during COVID-19 associated with better 3-month survival in geriatric patients: Extension phase of the GERIA-COVID study”. The Journal of Steroid Biochemistry and Molecular Biology 213 (2021): 105958.
  40. Lakkireddy M., et al. “Impact of daily high dose oral vitamin D therapy on the inflammatory markers in patients with COVID 19 disease”. Scientific Reports1 (2021): 10641.
  41. Sabico S., et al. “Effects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate Covid-19: A Randomized Clinical Trial”. Nutrients7 (2021).
  42. Liu N., et al. “Low vitamin D status is associated with coronavirus disease 2019 outcomes: a systematic review and meta-analysis”. International Journal of Infectious Diseases 104 (2021): 58-64.
  43. Moghaddam A., et al. “Selenium Deficiency Is Associated with Mortality Risk from COVID-19”. Nutrients 7 (2020): 2098.
  44. Munshi R., et al. “Vitamin D insufficiency as a potential culprit in critical COVID-19 patients”. Journal of Medical Virology 2 (2021): 733-740.
  45. Hackler J., et al. “Relation of Serum Copper Status to Survival in COVID-19”. Nutrients 6 (2021).
  46. Im JH., et al. “Nutritional status of patients with COVID-19”. International Journal of Infectious Diseases 100 (2020): 390-393.
  47. Majeed M., et al. “An exploratory study of selenium status in healthy individuals and in patients with COVID-19 in a south Indian population: The case for adequate selenium status”. Nutrition 82 (2021): 111053.
  48. Zeng HL., et al. “Urinary trace elements in association with disease severity and outcome in patients with COVID-19”. Environmental Research 194 (2021): 110670.
  49. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines”. National Institutes of Health (2019).
  50. Bomer N., et al. “Selenium and outcome in heart failure”. European Journal of Heart Failure8 (2020): 1415-1423.
  51. Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. “Dietary Reference Intakes for Vitamin C VE, Selenium, and Carotenoids”. Washington (DC): National Academies Press (US); (2000).
  52. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC TC, Yaktine AL, et al., editors. “Dietary Reference Intakes for Calcium and Vitamin D”. Washington (DC): National Academies Press (US); (2021).
  53. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional
  54. https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional
  55. Pincemail J., et al. “Oxidative Stress Status in COVID-19 Patients Hospitalized in Intensive Care Unit for Severe Pneumonia. A Pilot Study”. Antioxidants (Basel, Switzerland) 2 (2022).
  56. Tufan A., et al. “COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs”. Turkish Journal of Medical Sciences SI-1 (2020): 620-632.
  57. Magro G. “COVID-19: Review on latest available drugs and therapies against SARS-CoV-2. Coagulation and inflammation cross-talking”. Virus Research 286 (2020): 198070.
  58. Paces J., et al. “COVID-19 and the immune system”. Physiological Research 3 (2020): 379-388.
  59. Kieliszek M and Lipinski B. “Selenium supplementation in the prevention of coronavirus infections (COVID-19)”. Medical Hypotheses 143 (2020): 109878.
  60. Bermano G., et al. “Selenium and viral infection: are there lessons for COVID-19?” British Journal of Nutrition 6 (2018): 618-627.
  61. Avery JC and Hoffmann PR. “Selenium, Selenoproteins, and Immunity”. Nutrients 9 (2018): 1203.
  62. Pal A., et al. “Zinc and COVID-19: Basis of Current Clinical Trials”. Biological Trace Element Research8 (2021): 2882-2892.
  63. Delesderrier E., et al. “Selenium Status and Hemolysis in Sickle Cell Disease Patients”. Nutrients 9 (2019): 2211.
  64. Braunstein M., et al. “Selenium and Selenoprotein P Deficiency Correlates With Complications and Adverse Outcome After Major Trauma”. Shock1 (2020): 63-70.
  65. Salehi M., et al. “Selenium supplementation improves the nutritional status of hemodialysis patients: a randomized, double-blind, placebo-controlled trial”. Nephrology Dialysis Transplantation 3 (2013): 716-723.
  66. Yan D., et al. “Sodium Selenite Improves The Therapeutic Effect Of BMSCs Via Promoting The Proliferation And Differentiation, Thereby Promoting The Hematopoietic Factors”. Onco Targets Ther 5 (2019): 968.
  67. Mirmohammadsadeghi A., et al. “Effects of selenium supplementation on paraoxonase-1 and myeloperoxidase activity in subjects with cardiovascular disease: the Selenegene study, a double-blind randomized controlled trial”. Archives of Medical Sciences Atherosclerotic Diseases 3 (2018): e112-e118.
  68. Kazemi A., et al. “Association of Vitamin D Status with SARS-CoV-2 Infection or COVID-19 Severity: A Systematic Review and Meta-analysis”. Advances in Nutrition (2021).
  69. Shah K., et al. “Vitamin D supplementation, COVID-19 and disease severity: a meta-analysis”. QJM : Monthly Journal of the Association of Physicians3 (2021): 175-181.
  70. Carpagnano GE., et al. “Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19”. Journal of Endocrinological Investigation4 (2021): 765-771.
  71. Entrenas Castillo M., et al. “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study". The Journal of Steroid Biochemistry and Molecular Biology 203 (2020): 105751.
  72. Annweiler C., et al. “Vitamin D and survival in COVID-19 patients: A quasi-experimental study”. The Journal of Steroid Biochemistry and Molecular Biology 204 (2020): 105771.
  73. Radujkovic A., et al. “Vitamin D Deficiency and Outcome of COVID-19 Patients”. Nutrients9 (2020).
  74. Ling SF., et al. “High-Dose Cholecalciferol Booster Therapy is Associated with a Reduced Risk of Mortality in Patients with COVID-19: A Cross-Sectional Multi-Centre Observational Study”. Nutrients 12 (2020): 3799.
  75. Hastie CE., et al. “Vitamin D and COVID-19 infection and mortality in UK Biobank”. European Journal of Nutrition1 (2021): 545-548.
  76. Szeto B., et al. “Vitamin D Status and COVID-19 Clinical Outcomes in Hospitalized Patients”. Endocrine Research2 (2021): 66-73.
  77. Hastie CE., et al. “Vitamin D and COVID-19 infection and mortality in UK Biobank”. European Journal of Nutrition1 (2021): 545-548.
  78. Luo X., et al. “Vitamin D Deficiency Is Associated with COVID-19 Incidence and Disease Severity in Chinese People [corrected]”. The Journal of Nutrition1 (2021): 98-105.
  79. Vatandost S., et al. “Prevalence of vitamin D deficiency in Iran: A systematic review and meta-analysis”. Nutrition and Health4 (2018): 269-278.
  80. AlSafar H., et al. “COVID-19 Disease Severity and Death in Relation to Vitamin D Status among SARS-CoV-2-Positive UAE Residents”. Nutrients5 (2021): 1714.
  81. Sulli A., et al. “Vitamin D and Lung Outcomes in Elderly COVID-19 Patients”. Nutrients3 (2020).
  82. Charoenngam N and Holick MF. “Immunologic Effects of Vitamin D on Human Health and Disease”. Nutrients7 (2020): 2097.
  83. Trochoutsou AI., et al. “Vitamin-D in the Immune System: Genomic and Non-Genomic Actions”. Mini Reviews in Medicinal Chemistry11 (2015): 953-963.
  84. Alexander J., et al. “Early Nutritional Interventions with Zinc, Selenium and Vitamin D for Raising Anti-Viral Resistance Against Progressive COVID-19”. Nutrients8 (2020): 2358.
  85. Hansdottir S., et al. “Vitamin D decreases respiratory syncytial virus induction of NF-kappaB-linked chemokines and cytokines in airway epithelium while maintaining the antiviral state”. The Journal of Immunology 2 (2010): 965-974.
  86. Sassi ., et al. “Vitamin D: Nutrient, Hormone, and Immunomodulator”. Nutrients 10 (2018): 1656.
  87. L Bishop E., et al. “Vitamin D and immune regulation: antibacterial, antiviral, anti‐inflammatory”. JBMR Plus1 (2021): e10405.

Citation

Citation: Maryam Ekramzadeh., et al. “Mortality and Clinical Outcomes of Hospitalized COVID-19 Patients is Associated with Serum Concentrations of Selenium and Vitamin D".Acta Scientific Nutritional Health 7.4 (2023): 04-15.

Copyright

Copyright: © 2023 Maryam Ekramzadeh., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.316

Indexed In





News and Events


Contact US