The relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted to hospital with COVID-19.

BACKGROUND: Micronutrients have been associated with disease severity and poorer clinical outcomes in patients with COVID-19. However, there is a paucity of studies examining if the relationship with micronutrient status and clinical outcomes is independent of recognised prognostic factors, specifically frailty and the systemic inflammatory response (SIR). The aim of the present study was to examine the relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted with COVID-19. METHODS: Retrospective analysis of prospectively collected data was performed on patients with confirmed COVID-19, admitted to hospital between the 1st April 2020-6th July 2020. Clinicopathological characteristics, frailty assessment, biochemical and micronutrient laboratory results were recorded. Frailty status was determined using the Clinical Frailty scale. SIR was determined using serum CRP. Clinical outcomes of interest were oxygen requirement, ITU admission and 30-day mortality. Categorical variables were analysed using chi-square test and binary logistics regression analysis. Continuous variables were analysed using the Mann-Whitney U or Kruskal Wallis tests. RESULTS: 281 patients were included. 55% (n = 155) were aged ≥ 70 years and 39% (n = 109) were male. 49% (n = 138) of patients were frail (CFS > 3). 86% (n = 242) of patients had a serum CRP > 10 mg/L. On univariate analysis, frailty was significantly associated with thirty-day mortality (p < 0.001). On univariate analysis, serum CRP was found to be significantly associated with an oxygen requirement on admission in non-frail patients (p = 0.004). Over a third (36%) of non-frail patients had a low vitamin B1, despite having normal reference range values of red cell B2, B6 and selenium. Furthermore, serum CRP was found to be significantly associated with a lower median red cell vitamin B1 (p = 0.029). CONCLUSION: Vitamin B1 stores may be depleted in COVID-19 patients experiencing a significant SIR and providing rationale for thiamine supplementation. Further longitudinal studies are warranted to delineate the trend in thiamine status following COVID-19.

No energetic cost of tuberculosis infection in European badgers (Meles meles).

Energy availability and energy use directly influence an organism's life history, fitness and ecological function. In wild animals, abiotic factors such as ambient temperature, season and rainfall, and biotic factors such as body mass, age, social group size and disease status, all potentially influence energy balance. Relatively few studies have examined the effects of disease on the energy expenditure of wild animals. Such studies could further our understanding of factors influencing the transmission of zoonotic diseases. The European badger (Meles meles) is a medium-sized carnivore that occurs in mixed-sex, familial groups across much of its range. In the UK, they are a protected species but are also involved in the epidemiology of bovine tuberculosis (TB) in cattle. We measured the daily energy expenditure (DEE) and resting metabolic rate (RMR) of wild badgers and related this to their TB infection status and a range of other interacting factors including season, group size, disease status, sex, age, body mass and body fat. Individuals were larger and fatter when they were older, and fatter during the winter. Males were also heavier than females during the summer. In addition, individuals from smaller groups that were exposed to TB tended to have lower body mass. There were no direct effects of disease status on DEE or RMR; however, there was a significant interaction whereby DEE increased with body mass in small groups but decreased with body mass in large groups. Results are consistent with the costs of TB infection being met by compensatory mechanisms enabling badgers to survive for extended periods without exhibiting measurable energetic consequences.