Abstract Number: PB0211
Meeting: ISTH 2021 Congress
Background: Coronavirus disease 2019 (COVID-19) is associated with significant morbidity and mortality worldwide. Angiotensin-converting enzyme 2 (ACE2) represents the main receptor for SARS-CoV-2 to enter endothelial cells. Interestingly, controversial data have been reported for soluble ACE2 levels in COVID-19 patients.
Aims: Here we analyzed circulating ACE2 activity to correlate with routinely measured laboratory parameters as well as the severity and outcome of COVID-19 disease.
Methods: In this retrospective, dual-center study, we determined serum ACE2 activity from 57 subjects with moderate COVID-19 and 119 critically ill patients. ACE2 levels were correlated with IL-6 and ferritin concentrations and clinical outcome. In addition, ACE2 levels were also measured in follow-up samples (n=106).
Results: ACE2 activity was significantly higher in patients with severe COVID-19 (127.9 [83.1-209.7] vs. 73.8 [54.6-89.6] mU/L in non-severe patients; P<0.0001). Nevertheless, all COVID-19 patients had higher ACE2 than formerly measured serum ACE2 levels of healthy individuals (16.2 ± 0.8 mU/L) and of hypertensives (24.8 ± 0.8 mU/L) (Úri K et al., 2016). Circulating ACE2 showed a significant (P<0.0001) but moderate correlation with IL-6 (r=0.345) and ferritin (r=0.277). Substantial area under the receiver operating characteristic curve (ROC-AUC) value was determined for baseline ACE2 to indicate disease severity (0.774 [95% CI 0.702-0.846]; P<0.0001). Furthermore, significantly higher serum ACE2 was measured in non-surviving vs. surviving COVID-19 patients (131.2 [84.8-217.1] vs. 77.8 [56.5-123.0] mU/L; P<0.0001), and a high ACE2 level before treatment predicted poor outcome with a ROC-AUC value of 0.709 [95% CI 0.632-0.787] (P<0.0001). Finally, a larger elevation in ACE2 activity was observed compared to baseline values during monitoring in non-survivors vs. survivors (P<0.0001 vs. P=0.076).
Conclusions: Elevated serum ACE2 activity strongly correlates with both COVID-19 severity and prognosis, thus represents a promising laboratory biomarker.
To cite this abstract in AMA style:BN, Fejes Z, Nagy Z, Sütő R, Bíró E, Bekő G, Szentkereszty Z, Várkonyi I, Kappelmayer J, Papp Z, Tóth A, Fagyas M. Serum ACE2 Activity for the Assessment of Disease Prognosis in COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/serum-ace2-activity-for-the-assessment-of-disease-prognosis-in-covid-19/. Accessed November 28, 2023.
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