Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19. Patients aged ≥ 18 years with COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use from March 1, 2020 until March 31, 2021. After propensity score matching (1:1 ratio) based on the selected criteria, we assessed the association of zinc used as adjunctive therapy with the 30-day mortality. Secondary outcomes included the in-hospital mortality, ventilator free days, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay. A total of 164 patients were included, 82 patients received zinc. Patients who received zinc sulfate as adjunctive therapy have a lower 30-day mortality (HR 0.52, CI 0.29, 0.92; p = 0.03). On the other hand, the in-hospital mortality was not statistically significant between the two groups (HR 0.64, CI 0.37–1.10; p = 0.11). Zinc sulfate use was associated with a lower odds of acute kidney injury development during ICU stay (OR 0.46 CI 0.19–1.06; p = 0.07); however, it did not reach statistical significance. The use of zinc sulfate as an additional treatment in critically ill COVID-19 patients may improve survival. Furthermore, zinc supplementation may have a protective effect on the kidneys.

中文翻译：

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硫酸锌作为 COVID-19 危重患者辅助治疗的评估：一项两中心倾向评分匹配研究

锌是一种微量元素，在刺激先天性和获得性免疫力方面发挥作用。锌在 COVID-19 危重患者中的作用尚不清楚。本研究旨在评估硫酸锌作为辅助治疗对 COVID-19 危重患者的疗效和安全性。对 2020 年 3 月 1 日至 2021 年 3 月 31 日入住沙特阿拉伯两家三级医院重症监护室 (ICU) 的年龄≥ 18 岁的 COVID-19 患者进行锌的使用情况回顾性评估。倾向评分匹配后（1 :1 比率）根据选定的标准，我们评估了锌作为辅助治疗与 30 天死亡率的关联。次要结局包括院内死亡率、无需呼吸机的天数、ICU 住院时间 (LOS)、医院 LOS 和 ICU 住院期间的并发症。总共纳入了 164 名患者，其中 82 名患者接受了锌治疗。接受硫酸锌辅助治疗的患者 30 天死亡率较低（HR 0.52，CI 0.29，0.92；p = 0.03）。另一方面，两组之间的院内死亡率没有统计学意义（HR 0.64，CI 0.37-1.10；p = 0.11）。硫酸锌的使用与 ICU 住院期间发生急性肾损伤的几率较低相关（OR 0.46 CI 0.19–1.06；p = 0.07）；然而，它并未达到统计学显着性。使用硫酸锌作为重症 COVID-19 患者的附加治疗可能会提高生存率。此外，补充锌可能对肾脏有保护作用。