Nutrient deficiencies (Copper, Zinc, Iron, Magnesium) among children with SIRS/sepsis-a hospital based cross sectional study

Kiran Kartheek, Baliga B. S., . Subodhshetty, Prasanna Mithra, Charu Yadav


Background: In developing countries sepsis is a major etiological factor contributing to 60-80 % of annual mortality. SIRS/sepsis rates are high among children admitted to hospitals particularly in intensive care units. Oxidative stress plays important role in etio-pathogenesis of SIRS/sepsis. Nutrients with antioxidant activity enhance immune system there by decreasing severity of SIRS/sepsis. Estimation of such nutrient levels might establish relationship with oxidative stress in children with SIRS/sepsis.

Methods:A hospital based cross-sectional study was done on consecutive samples of 96 children diagnosed with SIRS/sepsis. Serum copper, iron zinc, magnesium levels of children diagnosed with sepsis/SIRS included in the study were estimated, data were represented as median with inter quartile range and proportions. Mann Whitney u test and Karl Pearson’s correlation tests were used to see correlation between clinical paramaters.

Results: Zinc and magnesium deficiency were seen in 68.8% and 59.4% children with SIRS/sepsis. Median serum magnesium levels were 1.24mg/dL in children with illness <1 week and 1.51mg/dL with illness >1week duration prior to hospitalization (p=0.017). Hospital acquired infections were higher with zinc (P=0.001) and copper deficiency(P=0.002). Zinc deficiency correlated with need for longer hospitalization (P= 0.017).  Mortality due to SIRS/sepsis increased as number of nutrient deficiencies increased (P =0.009).

Conclusions:Significant number of children with SIRS/sepsis had nutrient deficiencies. These deficiencies correlated significantly with duration of illness prior to hospitalization. Children with nutrient deficiency had higher incidence of hospital acquired infections. Children with normal nutrient levels have decreased length of hospitalization. Children with multiple nutrient deficiency had higher risk of death. 


Nutrient deficiency, Oxidative stress, Sepsis, Systemic inflammatory response syndrome

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Pavare J, Grope I, Gardovska D. Prevalence of systemic inflammatory response syndrome (SIRS) in hospitalized children: a point prevalence study. BMC Pediatr. 2009;9:25.

Galley HF. Bench-to-bedside review: Targeting antioxidants to mitochondria in sepsis. Crit Care. 2010;14(4):230.

World T, Day S, Sheet F. The World Sepsis Day Fact Sheet Sepsis The most common, but least recognized disease. (4):1-4.

D WMM, D DKHM. Pharmaconutrition with antioxidant micronutrients in the critically ill: The time has come ! Nutrition. Elsevier Inc.; 2013;29(1):359-60.

Visser J, Hospital TA. Micronutrients: do small things matter ? S Afr J Clin Nutr. 2010;23(1):58-61.

Wang G, Wang D, Jiang X, Yu X, Ma L, Zhong J, et al. Blood Zinc, Iron, and Copper Levels in Critically Ill Neonates. Biol Trace Elem Res 2014;164(1):8.

Heyland DK, Dhaliwal R, Suchner U, Berger MM. Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient. Intensive Care Med. 2005;31(3):327-37.

Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis. Crit Care. BioMed Central Ltd. 2012;16(2):66.

Talwar D, Duncan a., O’Reilly DS, Mcmillan DC. Op020 Quantitative Data on the Magnitude of the Systemic Inflammatory Response and Its Effect on Vitamins B1, B2 and B6 Based on Red Cell Measurements. Clin Nutr Suppl. 2012;7(1):9.

Artero A, Zaragoza R, Nogueira JM. Epidemiology of Severe Sepsis and Septic Shock Journal of Critical Care 2008;3-25.

Angelova M, Asenova S, Nedkova V. Copper in the human organism. Mol Biol Int. 2011;9(1):88-98.

Djoko KY, Ong CY, Walker MJ, McEwan AG. Copper and zinc toxicity and its role in innate immune defense against bacterial pathogens. J Biol Chem. 2015;115:647099.

Srinivasan MG, Ndeezi G, Mboijana C, Kiguli S, Bimenya GS, Nankabirwa V, et al. Zinc adjunct therapy reduces case fatality in severe childhood pneumonia: a randomized double blind placebo-controlled trial. BMC Med. BioMed Central Ltd. 2012;10(1):14.

Duncan A, Dean P, Simm M, O’Reilly DS, Kinsella J. Zinc supplementation in intensive care: Results of a UK survey. J Crit Care. Elsevier Inc. 2012;27(1):102.1-102.

Bresnahan K, Chileshe J, Arscott S, Nuss E, Surles R, Masi C, et al. The Acute Phase Response Affected Traditional Measures of Micronutrient Status in Rural Zambian Children during a Randomized, Controlled Feeding Trial. J Nutr. 2014;144(6):972-8.

Cojocaru IM, Cojocaru M, Tănăsescu R, Iacob SA, Iliescu I. Changes of magnesium serum levels in patients with acute ischemic stroke and acute infections. Rom J Intern Med. 2009;47(2):169-71.

Tam M, Gómez S, González-Gross M, Marcos a. Possible roles of magnesium on the immune system. Eur J Clin Nutr. 2003;57(10):1193-7.

Mehta N, Bechard L, Cahill N, Wang M. Nutritional practices and their relationship to clinical outcomes in critically ill children-An international multicenter cohort study. Crit Care Med. 2012;40(7):2204-11.

Comstedt P, Storgaard M, Lassen AT. The Systemic inflammatory response syndrome (SIRS) in acutely hospitalised medical patients: a cohort study. Scand J Trauma Resusc Emerg Med. 2009;17:67.

Dabhi L, Dabhi A. The role of micronutrients in ICU. 2014;69(2):32-4.