The association between micronutrient and hemogram values and prognostic factors in COVID‐19 patients: A single‐center experience from Turkey
Authors: Ersöz Ayşegül , Yılmaz Tarık Eren 
Published: February 2021

AbstractAimThe contribution of micronutrients to the immune system has been known for a long time. This study aimed to investigate the association between the micronutrient levels and hemogram values and prognostic factors of the disease in COVID‐19 patients in Ankara City Hospital.Materials and methodsOur study is a descriptive observational study based on a retrospective review of patient files. COVID‐19 patients over 18 years of age who were admitted to our hospital between 14 March and 1 June 2020, and with a complete micronutrient profile were included in the study. Age, gender, chronic diseases, micronutrient concentrations in the last 6 months, hemogram data on the day of hospitalization, total length of stay in hospital, and hospitalization to Intensive Care Unit (ICU)‐intubation‐death status of the patients were obtained from the patient files.ResultsA total of 310 patients whose parameters were thoroughly examined were included in our study; 51.9% of them were men and the mean age of all patients was 57.02 ± 18.28 years, and the most common comorbid disease was hypertension. The percentage of patients who were followed in the ICU, were intubated, and died was 34.5%, 13.9%, and 9.4%, respectively. The mean length of hospital stay was 15.87 ± 12.79 days. Low folate, iron, vitamin D, and hemoglobin levels of the patients and high vitamin B12 concentration were more related to poor prognostic factors. The number of white blood cells was significantly higher in patients with a worse prognosis, and the number of lymphocytes was lower in patients with ICU admission but higher in intubated and dead patients.ConclusionMicronutrient and hemogram values, advanced age, being male, and having comorbid diseases were correlated with the poor prognosis of COVID‐19 infection. Deficiency of Iron, Folate, and vitamin D should be well‐considered in COVID‐19. Excessive vitamin B12 and multivitamin supplementation should be avoided by choosing supplement wisely. In addition, attention should be paid to leukocytosis, lymphocyte counts, and anemia during COVID‐19 patient follow‐up. What’s known

Some micronutrients have an immunomodulatory and anti‐inflammatory effect with antioxidant effects and thus play a protective role in respiratory tract infections as COVID‐19.
Vitamin D deficiency is found to be associated with poor prognostic factors in COVID‐19.
Lymphopenia is found to be associated with poor prognostic factors in COVID‐19.
What’s new

According to the results obtained from our study, low iron and folate levels should be controlled first in patients diagnosed with COVID‐19, low vitamin D levels should also be well‐considered, and supplementation should be provided in the case of deficiencies. On the other hand excessive use of vitamin B12 should be avoided.
The fact that all micronutrients should be evaluated and managed by choosing wisely rather than a complete multivitamin supplement approach was demonstrated by the differences in the poor prognosis levels of vitamin B12 versus the other micronutrients.
In addition, it was found in our study that leukocytosis, lymphocyte counts, and anemia should be taken into consideration together when evaluating hemogram parameters in the follow‐up of COVID‐19 patients.