Serum ACE2 Level is Associated With Severe SARS-CoV-2 Infection: A Cross-Sectional Observational Study

Abstract

Objectives: Angiotensin-converting enzyme 2 (ACE2) represents the primary receptor for SARS-CoV-2 to enter endothelial cells, causing coronavirus disease of 2019 (COVID-19). In this study, we investigate the association between circulating ACE2 levels with the severity of COVID-19. Methods: Serum ACE2 levels were measured in 144 COVID-19-positive subjects at hospital admission, and 123 COVID-19-negative control subjects. The association between ACE2 and clinical outcomes was analyzed. Results: About 144 COVID-19 patients and 123 healthy controls data were analyzed, the mean age of patients was 62 years and 50% of them were males. The mean age of the control group was 55 years and 63% were males. ACE-II level was measured and compared between COVID-19 patients and controls and revealed no significant differences ( P > .05). ACE-II level was measured in COVID-19 patients and compared between different patient’s subgroups, ACE II level was not dependent on gender, smoking, ACE intake, or comorbidities ( P > .05), and was significantly correlated with cardiovascular diseases (CVS) ( P-value = .046) ICU admission ( P-value = .0007) and Death ( P-value = .0082). Conclusion: There was no significant difference between the COVID-19 and Control group, however, ACE2 serum level was significantly higher in patients with COVID-19 who were critically ill or non-survivors, its increased level is also associated with length of stay. Elevated ACE2 level is associated with the severity of COVID-19 disease, and it has the potential to be a predictor of the severity of the disease.

Evaluation of angiotensin converting enzyme 2 (ACE2), angiotensin II (Ang II), miR-141-3p, and miR-421 levels in SARS-CoV-2 patients: a case-control study

“…Also, Hani et al carried out a cross-sectional observational study on the association between serum sACE2 levels with the severity of COVID-19. They demonstrated that serum sACE2 levels did not change among SARS-CoV-2-positive and negative groups [ 33 ]. In addition, another study by Kintscher et al reported that sACE2 levels and the Ang II/Ang I peptide ratio did not change in COVID-19 patients [ 34 ].…”

“…Increased lysis of mACE2-expressing cells as a result of severe infection could explain the possible causes of increased serum sACE2 levels in critically ill/deceased patients compared to mild or non-severe patients. Measurement of serum sACE2 in COVID-19 patients admitted to the hospital and control subjects showed that sACE2 serum levels were markedly greater in more severe and non-survivor cases of COVID-19 than in the milder patients [ 43 ]. Therefore, some studies have suggested that sACE2 can be used as a possible predictor marker of COVID-19 severity [ 33 ].…”

“…Measurement of serum sACE2 in COVID-19 patients admitted to the hospital and control subjects showed that sACE2 serum levels were markedly greater in more severe and non-survivor cases of COVID-19 than in the milder patients [ 43 ]. Therefore, some studies have suggested that sACE2 can be used as a possible predictor marker of COVID-19 severity [ 33 ]. Contrary to these reports, several studies have demonstrated that serum/plasma sACE2 levels were significantly lower in severe COVID-19 patients than in the mild and healthy control subjects [ 44 ].…”