The objective of the present study was to evaluate of serum
metal levels in
COVID-19 patients with different disease severity, and to investigate the independent association between serum
metal profile and markers of lung damage. The cohort of
COVID-19 patients consisted of groups of subjects with mild, moderate, and severe illness, 50 examinees each. Forty-four healthy subjects of the respective age were involved in the current study as the control group. Serum
metal levels were evaluated using inductively-coupled plasma mass-spectrometry. Examination of
COVID-19 patients demonstrated that heart rate, respiratory rate, body temperature,
C-reactive protein levels, as well as lung damage increased significantly with
COVID-19 severity, whereas SpO2 decreased gradually. Increasing
COVID-19 severity was also associated with a significant gradual decrease in serum Ca, Fe, Se, Zn levels as compared to controls, whereas serum Cu and especially Cu/Zn ratio were elevated. No significant group differences in serum Mg and Mn levels were observed. Serum Ca, Fe, Se, Zn correlated positively with SpO2, being inversely associated with
fever, lung damage, and
C-reactive protein concentrations. Opposite correlations were observed for Cu and Cu/Zn ratio. In regression models, serum Se levels were inversely associated with lung damage independently of other markers of disease severity, anthropometric, biochemical, and
hemostatic parameters. Cu/Zn ratio was also considered as a significant predictor of lower SpO2 in adjusted regression models. Taken together, these findings demonstrated that
metal metabolism significantly interferes with
COVID-19 pathogenesis, although the causal relations as well as precise mechanisms are yet to be characterized.