Abstract
Objectives
Angiotensin-converting enzyme 2 (ACE2) represents the primary receptor for SARS-CoV-2 to enter endothelial cells. Here we investigated circulating ACE2 activity to predict the severity and mortality of COVID-19.
Methods
Serum ACE2 activity was measured in COVID-19 (110 critically ill and 66 severely ill subjects at hospital admission and 106 follow-up samples) and in 32 non-COVID-19 severe sepsis patients. Associations between ACE2, inflammation-dependent biomarkers, pre-existing comorbidities, and clinical outcomes were studied.
Results
Initial ACE2 activity was significantly higher in critically ill COVID-19 patients (54.4 [36.7-90.8] mU/L) than in severe COVID-19 (34.5 [25.2-48.7] mU/L; P<0.0001) and non-COVID-19 sepsis patients (40.9 [21.4-65.7] mU/L; P=0.0260) regardless of comorbidities. Circulating ACE2 activity correlated with inflammatory biomarkers and was further elevated during the hospital stay in critically ill patients. Based on ROC-curve analysis and logistic regression test, baseline ACE2 independently indicated the severity of COVID-19 with an AUC value of 0.701 (95% CI [0.621-0.781], P<0.0001). Furthermore, non-survivors showed higher serum ACE2 activity vs. survivors at hospital admission (P<0.0001). Finally, high ACE2 activity (≥45.4 mU/L) predicted a higher risk (65 vs. 37%) for 30-day mortality (Log-Rank P<0.0001).
Conclusions
Serum ACE2 activity correlates with COVID-19 severity and predicts mortality.
【저자키워드】 SARS-CoV-2, Inflammation, ACE2, Biomarker, Sepsis, outcome, COVID-19 disease, 【초록키워드】 COVID-19, Biomarkers, Mortality, severe COVID-19, severity, Comorbidities, Clinical outcome, serum, Critically ill, severity of COVID-19, endothelial cells, Logistic regression, Hospital admission, Follow-up, receptor, predict, critically ill patients, 30-Day mortality, Inflammatory biomarker, Analysis, COVID-19 patient, Hospital stay, Non-COVID-19, higher risk, 95% CI, subject, enzyme, circulating, AUC value, sepsis patients, survivor, objective, non-survivor, Result, was measured, predicted, indicated, investigated, elevated, correlated, significantly higher, baseline, sepsis patient, with COVID-19, 【제목키워드】 Mortality, disease severity, predict, hospitalized COVID-19 patient,