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The independent association between plasma and red blood cell zinc levels with long-term outcomes of hospitalized patients


Background — Plasma and red blood cell (RBC) zinc values are unrelated in hospitalized patients. The independent association of these values with important patient outcomes is unknown.

Methods — Plasma and RBC zinc were prospectively measured within 48 hours of hospitalization in consenting patients. Data were linked deterministically with population-based health administrative data to measure each zinc measures’ association with two outcomes (time to death from any cause, likelihood of death or urgent readmission to hospital within 30-days of discharge) after adjusting for validated outcome risk scores.

Results — 250 people admitted to medical services were studied. Patients were ill with a 1-year baseline expected death risk [interquartile range] of 19.9% [6.3-37.2]. Observed 1- and 2-year all-cause death risk was 24.5% (95%CI 19.6-30.3) and 33.2% (27.3-39.9), respectively. Death risk increased significantly as plasma zinc levels decreased (p=0.0001). This association persisted even after adjusting for baseline expected death risk (p=0.02) with every 2 μmol/L decrease in plasma zinc being independently associated with, on average, a 35% increase in death risk. RBC zinc was not associated with death risk. Neither plasma nor RBC zinc levels were significantly associated with 30-day death or urgent readmission.

Conclusions — Plasma, but not RBC, zinc levels are independently associated with all-cause death risk in hospitalized medical patients. Further study is required to determine whether this association is causal and identify its potential causal pathways.



Rodic S, McCudden C, van Walraven C. Curr Dev Nutr. 2023; Mar 2 [Epub ahead of print].

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