Associations of blood essential and toxic metal(loid)s with both disease severity and mortality in patients with COVID-19: a retrospective study

Abstract Background The variations and dynamics of blood essential and toxic metal(loid)s in patients with COVID-19 still remains unclear.Methods A retrospective study was performed in a cohort of confirmed COVID-19 patients for their whole blood levels of essential and/or toxic metal(loid)s including magnesium, calcium, chromium, manganese, iron, copper, zinc, arsenic, cadmium, mercury, thallium and lead according to the disease severity and outcome.Results Compared to the non-severe COVID-19 patients, Whole blood calcium, chromium and copper were higher in the severe patients, while magnesium, manganese, iron, zinc, arsenic, thallium and lead were lower. These differences were further found to be consistently existed across the clinical course since the disease onset by longitudinal analysis. Moreover, among the severe patients, chromium and cadmium were higher in the deceased group compared to the recovered group, while arsenic were found to be lower. Whole blood iron, arsenic, and age and sex were determined to be independently factors associated with the disease severity, while chromium, cadmium and the co-morbidity of cardiovascular disease were determined to be independently factors associated with the mortality.Conclusions These results suggest variations of whole blood metal(loid)s as associated factors correlated with the disease severity and mortality for COVID-19.