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The Minimal Effect of Zinc on the Survival of Hospitalized Patients With COVID-19: An Observational Study.

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      To the Editor: Zinc is an investigational agent against coronavirus disease 2019 (COVID-19) and has known preventative and therapeutic roles in other infections.[[1]] Zinc deficiency is associated with lower survival among older patients with pneumonia and predisposes to other viral infections.[3] Established risk factors for critical COVID-19, including older age, diabetes mellitus, and cardiovascular disease, are also associated with zinc deficiency.[2] The antiviral and immunomodulatory effects of zinc have made it a candidate against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection.[[2]] Zinc may decrease the activity of the angiotensin converting enzyme 2, the receptor for SARS-CoV-2. Our primary analysis explored the causal association between zinc therapy and the survival of hospitalized patients with COVID-19. To explore the additive effect of zinc therapy on various therapies, we performed subgroup analyses among patients who received hydroxychloroquine, lopinavir/ritonavir, steroids, and IL-6 receptor inhibitors. Secondary analysis using multivariable Cox regression with IPW for zinc therapy further assessed the association between zinc therapy and the primary outcome. [Extracted from the article]