Assessment of micronutrient levels in patients with post COVID musculoskeletal manifestations - A cross-sectional observational study.

Abstract

Introduction: Micronutrients are key regulators of human metabolism and influence time to recovery and post-COVID complications. In this study, we aimed to assess the prevalence of micronutrient deficiency and its association with the severity of post-COVID musculoskeletal manifestations.

Materials and methods: This cross-sectional observational study was conducted in a tertiary care center. The study was registered in the Clinical Trial Registry of India (CTRI number: CTRI/2022/07/044336) Patients aged 18-65 years attending the post-COVID clinic with musculoskeletal manifestations were included. Patients' demographics, personal habits, and clinical history specific to the course of COVID-19 were collected and a physical examination was performed. Blood samples were collected to assess iron, selenium, zinc, and copper, and complete blood picture with differential count and C-reactive protein (CRP) assay. Musculoskeletal manifestations during the post-COVID phase (within a year after the COVID-19 infection) such as fatigue, myalgia, arthralgia, myositis, fibromyalgia, and arthralgia were documented. Copper and zinc levels were analysed at the National Institute of Nutrition and all other parameters were analysed in our institute. Continuous data expressed as mean, and standard deviation, and analysed by independent t-test. Categorical data expressed as frequency (percentage) and analyzed by Pearson Chi-square test. Pearson correlation test was done to find out correlation between micronutrients and arthritis.

Results: The data collected from 166 individuals were analyzed, and micronutrient deficiencies were observed in 66 (39.7%) for iron, 43 (25.9%) for selenium, 30 (18.07%) for copper, and 7 (4.2%) for zinc. Multivariate analysis showed the presence of arthritis was negatively correlated with serum selenium levels (r = -0.459 and P = 0.001), copper (r = -0.537 and P = 0.001) and positively correlated with CRP (r = 0.439 and P = 0.001). The area under receiver operating curve and 95% confidence intervals were 0.85 (0.771-0.928) for selenium, 0.593 (0.481-0.705) for iron, 0.71 (0.602-0.818) for zinc and 0.782 (0.679-0.885) for copper.

Conclusion: Our research found a significant association between micronutrient deficiency of iron, copper, and selenium with the severity of musculoskeletal manifestations in the post-COVID-19 phase. A 40% prevalence of at least one micronutrient deficiency was observed in our study population which comprised of patients with musculoskeletal manifestations in the post-COVID-19 phase.