Back
The angiotensin converting enzyme 2 (ACE2) is the cell entry receptor for SARS-CoV-2. SARS-CoV2 participates in ACE2 shedding from cell membrane, increasing soluble ACE2. The present study aims to evaluate if circulating ACE2 activity may be a tool to predict SARS-CoV2 severe disease.
During the first wave of COVID-19 pandemic (March and April 2020), first emergency attendance serum samples were collected from 1501 COVID-19 patients diagnosed at Vall d’Hebron and Hospital Clínic Hospitals in Barcelona. Age, sex, previous comorbidities, and clinical and analytical variables were collected from the patient’s records. Patients that were admitted to intensive care unit (ICU), required mechanical ventilation or died due to COVID-19 were considered severe patients. Serum ACE2 activity was measured by enzymatic activity assay.
Patients with severe COVID-19 were older and presented more comorbidities (Table 1). Circulating ACE2 activity at admission was increased in 0.38 relative fluorescence units (RFUs)/ng/mL (95%CI: 0.27–0.48, p<0.001) in patients that developed severe COVID-19. The logistic regression model adjusted by age, sex, diabetes, hypertension, obesity, cardiovascular disease and chronic kidney disease identified that high circulating ACE2 activity was associated with worse SARS-CoV2 disease (OR: 2.1, 95%CI: 1.7–2.6, p<0.001). High circulating ACE2 activity ≥0.59 RFU/ng/μL provided the best sensitivity (59%) and specificity (65%) relation, whereas ACE2 activity values ≥1.3 RFU/ng/μL were significantly related to a worse prognosis of the disease with a 95% specificity.
Elevated circulating ACE2 activity at first admission to the Emergency Department is a risk factor for severe COVID-19 disease.