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The Prognostic Value of Serum Zinc Levels in Acutely Hospitalized Patients: a Systematic Review

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Abstract

Several small studies have identified possible associations between low serum zinc levels and worse outcomes in patients acutely hospitalized for a variety of diseases. This study systematically evaluated all published literature to determine whether serum zinc might independently predict important outcomes in hospitalized patients. PubMed, Embase, and Cochrane Libraries databases were searched from 1970 to 2019 to identify all citations having the keyword “zinc” with hospital outcomes. Studies were included if they measured the association between serum zinc levels in non-electively hospitalized patients with survival, length of stay, or unplanned readmission. Data were double-abstracted to evaluate the association between zinc levels and these outcomes. Our search returned 1091 citations of which 12 studies met the inclusion criteria. Studies were small (median 112.5 patients) using unspecified sampling methods. Seven studies were restricted to critically ill patients. Mean zinc levels ranged from 27.5 to 85.3 μg/dL. Baseline mean zinc levels were significantly lower (p < 0.05) in patients who eventually died in 1 of 7 studies. Five of seven studies found significantly increased risk of death in hospital with lower zinc levels. Associations between zinc levels and critical care or hospital length of stay were unclear. In 1 study, lower zinc levels were associated with a significantly increased risk of unplanned readmission. Current studies measuring the association between serum zinc levels and outcomes in acutely hospitalized patients are limited by their sample sizes, select patient populations, and limited statistical analyses. The association of zinc levels with hospital patient outcomes is unclear.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Ottawa, Ottawa, Canada

    Stefan Rodic

  2. Department of Pathology & Lab. Medicine, University of Ottawa, Ottawa, Canada

    Christopher McCudden

  3. Division of Biochemistry, The Ottawa Hospital, Ottawa, Canada

    Christopher McCudden

  4. Medicine and Epidemiology & Community Medicine, University of Ottawa, Carling Ave, Ottawa, ON, K1Y 4E9, Canada

    Carl van Walraven

  5. Ottawa Hospital Research Institute, Ottawa, Canada

    Carl van Walraven

  6. Institute for Clinical Evaluative Sciences, Toronto, Canada

    Carl van Walraven

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  1. Stefan Rodic
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  2. Christopher McCudden
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  3. Carl van Walraven
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Correspondence to Carl van Walraven.

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Appendices

Appendix 1

MedLine search strategies used for systematic review.

  1. A.

    Primary search strategy (using PubMed platform): ((serum zinc) OR (blood zinc)) AND ((mortality) OR (readmission) OR (length of stay))

This search returned 1075 citations (Fig. 1)

  1. B.

    Secondary search strategy (Using OvidR platform):

1

*Zinc/bl [Blood]

2

*Zinc/df [Deficiency]

3

1 or 2

4

limit 3 to (humans and yr = “1970–2019”)

5

Prognosis/

6

*Biomarkers/bl [Blood]

7

Hospital Mortality/

8

Survival Rate/ or Survival/

9

“Length of Stay”/

10

5 or 6 or 7 or 8 or 9

11

4 and 10

  1. This search returned 117 citations

Appendix 2

Table 4 PRISMA 2009 checklist
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Rodic, S., McCudden, C. & van Walraven, C. The Prognostic Value of Serum Zinc Levels in Acutely Hospitalized Patients: a Systematic Review. Biol Trace Elem Res 199, 4447–4457 (2021). https://doi.org/10.1007/s12011-021-02575-8

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  • DOI: https://doi.org/10.1007/s12011-021-02575-8

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