Impact of Zinc Supplementation on the Clinical Outcomes of Patients with Severe Head Trauma: A Double-Blind Randomized Clinical Trial

ABSTRACT

To determine the effects of zinc supplementation on clinical outcomes of patients with severe head trauma, this double-blind clinical trial randomly allocated 100 patients with severe head trauma, aged between 18 to 65 years, to receive placebo or 120 mg zinc via a nasogastric tube for 15 days. Plasma zinc and copper, 24-hour urinary zinc excretion, Sequential Organ Failure Assessment (SOFA) were assessed on days 1, 7, and 16. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count were measured on days 1 and 16. Glasgow outcome score (GOS), mortality rate on day 28, and length of stay (LOS) were compared between groups. There were no significant differences in baseline data between groups (all p > .05). Mean plasma zinc concentration was significantly higher in the zinc group than the placebo group on day 7 (119.5 vs. 81.7 µg/dl, p < .001) and day 16 (124.1 vs. 101.1 µg/dl, p < .001). The SOFA, GOS, and inflammation factors were significantly better in the zinc-supplemented group by day 16 (all p < .05). The LOS was shorter (52 vs. 65 days, p = .043) and mortality rate on day 28 was borderline lower (17% vs. 22%, p = .507) in zinc versus placebo groups. Zinc supplementation in the study had favorable effects on GOS, SOFA score, and inflammatory markers in patients with severe head injury.

KEYWORDS:

• GCS
• severe head trauma
• SOFA
• zinc administration

Acknowledgments

The authors thank the Neurosurgery ICU, neurosurgery residents and other physicians, and nursing staff at Shahid-Kamyab Hospital of Mashhad for assistance in the performance of this study.

Declaration of interest

The authors declare no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This work was supported by grants from the Mashhad Medical University.

About the authors

Maryam Khazdouz, MSc, PhD candidate of nutrition at IRAN University of Medical Sciences (IUMS).

Mohsen Mazidi, MSc, is a research fellow in the Academy of Sciences. He works on the mechanism of bariatric surgery in rodent models. His research interests include novel risk factors for non-communicable diseases.

Mohammad-reza Ehsaei, MD, professor of neurosurgery at Mashhad University of Medical Sciences.

Gordon Ferns, MD, DSc, is professor of medical education and metabolic medicine. He has had long term research interest in factors associated with cardiovascular risk, and the pathophysiological role of trace metals.

Andre Pascal Kengne, PhD, is the director of the Non-Communicable Diseases Research Unit at the South African Medical Research Council in Cape Town, South Africa. His research interests include chronic non-communicable diseases in Africa and developing countries in general, and prognostic and translational research.

Abdol-Reza Norouzy, MD, PhD, head of the Department of Nutrition and associate professor in clinical nutrition at Mashhad Medical School.