Low serum zinc level: The relationship with severe pneumonia and survival in critically ill children

摘要

Summary Background Zinc deficiency is common among children in developing countries; but, there is still conflicting evidence on whether the alteration in zinc metabolism is the predictive of disease severity in the setting of critical illness. Objectives To assess serum zinc levels in children admitted with pneumonia, and also to study the relationship between zinc levels and severity and mortality from pneumonia. Methods In a prospective cohort study, we enrolled 320 critically ill children admitted to the paediatric intensive care unit ( PICU ) with severe pneumonia (group 1) in addition to 160 children admitted into wards with pneumonia (group 2). Serum zinc measured in all patients on admission. Results Serum zinc level was significantly lower among patients admitted to PICU (group 1) compared with patients admitted to wards (group 2) ( P ??.001). There was a highly statistically significant decrease in zinc level in critically ill children complicated by sepsis, mechanically ventilated cases and those who died. Regarding the diagnosis of sepsis, zinc had an area under the curve ( AUC ) of 0.81 while C‐reactive protein ( CRP ) had an AUC of 0.83. Regarding the prognosis, zinc had an AUC of 0.649 for prediction of mortality, whereas the AUC for Pediatric risk of mortality ( PRISM ), Pediatric index of mortality2 ( PIM 2) and CRP were 0.83, 0.82 and 0.78, respectively. The combined zinc with PRISM and PIM 2 has increased the sensitivity of zinc for mortality from 86.5% to 94.9%. Conclusion Zinc has both a diagnostic and a prognostic value for children with pneumonia.