Persistent low serum zinc is associated with recurrent sepsis in critically ill patients - A pilot study

Abstract

Zinc is an essential trace element for both pathogens and hosts. Hypozincemia is a well known phenomenon in sepsis patients and represents the innate immune systems attempt to deprive pathogens of zinc. However little is known about course, restitution and prognostic value of serum zinc levels in sepsis patients. We performed a prospective observational single-center study set in a tertiary care university hospital intensive care unit. Serum zinc levels were singularly measured of healthy controls and sequentially of surgical sepsis patients and surgical patients over a 8-day period. Throughout the study period, we report significantly decreased serum zinc levels in surgical and surgical sepsis patients compared to healthy controls. Lower serum zinc levels in surgical sepsis patients were associated with a higher susceptibility to a recurrent sepsis episode. Furthermore, surgical sepsis patients with a higher number of organ dysfunctions and increased in-hospital mortality at day 28 and 90 showed lower serum zinc levels at admission. We report serum zinc levels as a promising biomarker in the diagnosis and evaluation of sepsis patients. However, it is still unclear whether these findings are caused by an over-amplified redistribution of zinc during acute-phase response, or whether the critically ill patients were zinc deficient before sepsis.

Fig 1. Total serum zinc, Procalcitonin (PCT) and C-reactive Protein (CRP) levels at admission (TA) divided by groups (a-c) or number of organ dysfunctions (d-f) among sepsis patients.

Data are shown as mean + SEM and analyzed by one-way ANOVA followed by Dunnett’s post hoc test.

Fig 2. Development of a recurrent sepsis episode in sepsis patients within 28 days after enrolment.

Sepsis patients, who died within the first septic episode, were excluded from this subset analysis. Sequentially measured a) Total serum zinc, b) Procalcitonin (PCT) and c) C-reactive protein (CRP) levels at admission (TA) are shown as mean + SEM and analyzed by unpaired t-test followed by Bonferroni-Holm procedure for multiple comparison. Significant differences are indicated by * (= p ≤ 0.05).

Fig 3. In- hospital mortality of sepsis patients after 28 (a-c) and 90 days (d-f) of enrollment.

Total serum zinc, Procalcitonin (PCT) and C-reactive protein (CRP) levels at admission (TA) are shown as mean ± SEM in survivors and non-survivors of sepsis. Significant differences are indicated by * (= p ≤ 0.05).