Treatment with Zinc is Associated with Reduced In-Hospital Mortality Among COVID-19 Patients: A Multi-Center Cohort Study
Frontera et al.,
Treatment with Zinc is Associated with Reduced In-Hospital Mortality Among COVID-19 Patients: A Multi-Center..,
Research Square, doi:10.21203/rs.3.rs-94509/v1 (Preprint)
Retrospective 3,473 hospitalized patients showing lower mortality with HCQ+zinc.
risk of death, 37.0% lower, HR 0.63, p = 0.01, treatment 121 of 1,006 (12.0%), control 424 of 2,467 (17.2%), NNT 19, adjusted per study, PSM.
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risk of death, 24.0% lower, HR 0.76, p = 0.02, treatment 121 of 1,006 (12.0%), control 424 of 2,467 (17.2%), NNT 19, adjusted per study, regression.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Frontera et al., 26 Oct 2020, retrospective, propensity score matching, USA, preprint, median age 64.0, 14 authors, this trial uses multiple treatments in the treatment arm (combined with zinc) - results of individual treatments may vary.
Abstract: Treatment with Zinc is Associated with Reduced In-Hospital Mortality
Among COVID-19 Patients: A Multi-Center Cohort Study
Jennifer A. frontera ( jennifer.frontera@nyulangone.org )
NYU Langone Health https://orcid.org/0000-0002-0719-2522
Joseph O. Rahimian
NYU Langone Health
Shadi Yaghi
NYU Langone Health
Mengling Liu
NYU Langone Health
Ariane Lewis
NYU Langone Health
Adam de Havenon
University of Utah Health
Shraddha Mainali
Ohio State University Foundation: The Ohio State University
Joshua Huang
NYU Langone Health
Erica Scher
NYU Langone Health
Thomas Wisniewski
NYU Langone Health
Andrea B. Troxel
NYU Langone Health
Sharon Meropol
NYU Langone Health
Laura J. Balcer
NYU Langone Health
Steven L. Galetta
NYU Langone Health
Research article
Keywords: Zinc, ionophore, treatment, mortality, COVID-19, SARS-CoV-2
DOI: https://doi.org/10.21203/rs.3.rs-94509/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License
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Abstract
Background: Zinc impairs replication of RNA viruses such as SARS-CoV-1, and may be effective against SARS-CoV-2. However, to achieve adequate
intracellular zinc levels, administration with an ionophore, which increases intracellular zinc levels, may be necessary. We evaluated the impact of zinc
with an ionophore (Zn+ionophore) on COVID-19 in-hospital mortality rates.
Methods: A multicenter cohort study was conducted of 3,473 adult hospitalized patients with reverse-transcriptase-polymerase-chain-reaction (RT-PCR)
positive SARS-CoV-2 infection admitted to four New York City hospitals between March 10 through May 20, 2020. Exclusion criteria were: death or
discharge within 24h, comfort-care status, clinical trial enrollment, treatment with an IL-6 inhibitor or remdesivir. Patients who received Zn+ionophore
were compared to patients who did not using multivariable time-dependent cox proportional hazards models for time to in-hospital death adjusting for
confounders including age, sex, race, BMI, diabetes, week of admission, hospital location, sequential organ failure assessment (SOFA) score, intubation,
acute renal failure, neurological events, treatment with corticosteroids, azithromycin or lopinavir/ritonavir and the propensity score of receiving
Zn+ionophore. A sensitivity analysis was performed using a propensity score-matched cohort of patients who did or did not receive Zn+ionophore
matched by age, sex and ventilator status.
Results: Among 3,473 patients (median age 64, 1947 [56%] male, 522 [15%] ventilated, 545[16%] died), 1,006 (29%) received
Zn+ionophore. Zn+ionophore was associated with a 24% reduced risk of in-hospital mortality (12% of those who received Zn+ionophore died versus 17%
who did not; adjusted Hazard Ratio [aHR] 0.76, 95% CI 0.60-0.96, P=0.023). More patients who received Zn+ionophore were discharged home (72%
Zn+ionophore vs 67% no Zn+ionophore, P=0.003) Neither Zn nor the ionophore alone were associated with decreased mortality rates. Propensity scorematched sensitivity analysis (N=1356) validated these results (Zn+ionophore aHR for mortality 0.63, 95%CI 0.44-0.91, P=0.015). There were no
signi cant interactions for Zn+ionophore with other COVID-19 speci c medications.
Conclusions: Zinc with an ionophore was associated with increased rates of discharge home and a 24% reduced risk of in-hospital mortality among
COVID-19 patients, while neither zinc alone nor the ionophore alone reduced mortality. Further randomized trials are..
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