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Serum zinc in critically ill adult patients with acute respiratory failure

Authors


  • Part of the results have been presented as an abstract at the 22nd European Society of Intensive Care Annual Congress, Wien, 2009.

  • *The FINNALI Study Group: Participating hospitals and investigators: Satakunta Central Hospital – Dr Vesa Lund, Päivi Tuominen, Pauliina Perkola – East Savo Central Hospital – Dr Markku Suvela, Sirpa Kauppinen, Anne-Marja Turkulainen – Central Finland Central Hospital – Dr Raili Laru-Sompa, Tiina Kirkhope, Sirpa Nykänen – South Savo Central Hospital – Dr Heikki Laine, Kirsi Reponen, Pekka Kettunen – North Karelia Central Hospital – Dr Matti Reinikainen, Tanja Eiserbeck, Helena Jyrkönen – Seinäjoki Central Hospital – Dr Kari Saarinen, Dr Matti Viitanen, Niina Siirilä, Johanna Soini – South Karelia Central Hospital – Dr Seppo Hovilehto, Dr Anne Kirsi, Dr Pekka Tiainen, Sanna Asikainen – Päijät-Häme Central Hospital – Dr Pekka Loisa – Vaasa Central Hospital, Dr Pentti Kairi – Kanta-Häme Central Hospital – Dr Risto Puolakka, Piia Laitinen, Tarja Heikkilä– Lappi Central Hospital – Dr Outi Kiviniemi, Tarja Laurila, Tiina Pikkuhookana – Keski-Pohjanmaa Central Hospital – Dr Samuli Forsström, Dr Tadeusz Kaminski, Tuija Kuusela – Kymenlaakso Central Hospital – Dr Jussi Pentti, Dr Seija Alila, Reija Koskinen – Helsinki University Hospital – Jorvi Hospital – Dr Tero Varpula, Mira Rahkonen – Meilahti Hospital ICU, Dr Anne Kuitunen, Dr Anna-Maija Korhonen, Dr Rita Linko, Dr Marjatta Okkonen, Janne Myller, Jarmo Pekkola, Leena Pettilä, Sari Sutinen – Meilahti Hospital, Cardiac Surgical ICU – Dr Raili Suojaranta-Ylinen, Dr Sinikka Kukkonen, Elina Nurmi-Toivonen – Meilahti Hospital, Department of Medicine – Dr Tom Bäcklund, Dr Juhani Rossinen, Riina Mäkelä– Töölö Hospital – Dr Janne Reitala, Dr Jyrki Vuola, Raija Niemi, Marja-Leena Pihlajamaa, Aira Uusipaavalniemi – Surgical Hospital – Dr Anna-Maria Koivusalo, Pasi Kyllönen – Turku University Hospital – Dr Juha Perttilä, Dr Erkki Kentala, Dr Olli Arola, Dr Outi Inkinen, Jutta Kotamäki – Tampere University Hospital – Dr Sari Karlsson, Dr Jyrki Tenhunen, Minna-Liisa Peltola, Sanna Mäkinen, Anna-Liina Korkala, Samuli Kortelainen – Kuopio University Hospital – Dr Esko Ruokonen, Dr Ilkka Parviainen, Sari Rahikainen, Elina Halonen – Oulu University Hospital – Dr Tero Ala-Kokko, Dr Jouko Laurila, Sinikka Sälkiö, Tarja Lamberg.

Address:
Rita Linko
Helsinki University Hospital
Anesthesia and Intensive Care Medicine
Sairaalakatu 1
PL 900, 00029 HUS
Finland
e-mail: rita.linko@hus.fi

Abstract

Background and aims: Zinc deficiency leads to susceptibility to infections and may affect pulmonary epithelial cell integrity. Low zinc levels have also been associated with a degree of organ failure and decreased survival in critically ill children. Accordingly, the purpose of the study was to assess serum zinc in adult patients with acute respiratory failure, its association with ventilatory support time, intensive care unit (ICU) length of stay (LOS), organ dysfunction and 30-day mortality.

Methods: We included consecutive patients with acute respiratory failure during an eight-week prospective, observational multicentre study (the FINNALI-study). Acute respiratory failure was defined as a need for either non-invasive or invasive positive pressure ventilation for >6 h regardless of the underlying cause or risk factors. After informed consent, a sample for zinc measurement was drawn at 6 h after the start of treatment and analysed from 551 of these patients.

Results: Low serum zinc was frequent (95.8%) at the onset acute respiratory failure. The median interquartile range [IQR] was 4.7 [3.0–6.9] μmol/l. The median [IQR] serum zinc levels in non-infectious, sepsis and septic shock patients were 5.0 [3.1–7.1], 5.1 [3.5–7.3] and 3.8 [2.6–5.9] μmol/l, respectively, P<0.01. Baseline zinc levels were not associated with ventilatory support time (P=0.98) or ICU LOS (P=0.053). The area under curve in receiver operating characteristics analysis for serum zinc regarding 30-day mortality was 0.55 (95% CI 0.49–0.60).

Conclusions: Serum zinc on initiation of ventilation had no predictive value for 30-day mortality, ventilatory support time or intensive care unit LOS.

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