Predictors of Hair Zinc Deficiency and Its Association with the Severity of Community-Acquired Pneumonia in Dr. Cipto Mangunkusumo National General Hospital

Rosatya Imanuela¹, Gurmeet Singh², Nurul Ratna Mutu Manikam³, Kuntjoro Harimurti¹, Juferdy Kurniawan¹, Cleopas Martin Rumende², Sally Aman Nasution¹, Noto Dwimartutie¹

¹Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital

²Divison of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital

³Department of Nutrition, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National General Hospital

Corresponding Author:

Gurmeet Singh, MD, PhD

Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital

Jalan Diponegoro 71, Central Jakarta, Indonesia

Email: gurmeetsingh10@yahoo.com

Abstract

Background: Zinc deficiency can cause immune disorders that can increase the severity of community-acquired pneumonia (CAP). One of the potential biomarkers of zinc deficiency is hair zinc levels because they are more stable. However, because zinc levels are not routinely tested, clinical predictors are needed to determine the profile of patients at risk of zinc deficiency, especially in CAP patients.

Methods: This study is a cross-sectional study using primary data. Ninety-three adult patients who were hospitalized with CAP at Cipto Mangunkusomo National General Hospital in July-August 2023 were included in this study. Sampling used the consecutive sampling method. Hair zinc levels were analyzed using spectrophotometry. Zinc intake during the last month was assessed using a semiquantitative food frequency questionnaire (FFQ). Medical history was obtained from hospital medical records and laboratory examinations. Bivariate tests using chi-square tests were performed on age, sex, nutritional status, diabetes mellitus, malabsorption, chronic kidney disease, liver cirrhosis, HIV/AIDS, and malignancies with hair zinc deficiency. Identification of predictors for hair zinc deficiency was carried out using a multivariate logistic regression test. A bivariate test was also performed using chi-square to assess the association between hair zinc deficiency and the severity of CAP, and then a multivariate analysis was performed on confounding variables.

Results: 10.75% of patients experienced hair zinc deficiency. Predictors for hair zinc deficiency in community-acquired pneumonia patients were diabetes mellitus (PR 4.800; 95% CI 1.339 – 17.199) and HIV/AIDS status (PR 6.000; 95% CI 1.356 – 26.544). There was no significant relationship between hair zinc deficiency and the severity of CAP.

Conclusion: The prevalence of hair zinc deficiency in this study population was 10.75%. Predictors for hair zinc deficiency in community-acquired pneumonia patients are diabetes mellitus and HIV/AIDS. However, there was no association between hair zinc deficiency and the severity of CAP in this study population.

Keywords: predictors, hair zinc deficiency, community-acquired pneumonia