Predictors of COVID-19 severity among a cohort of Egyptian patients

Abstract

Abstract Background As the outbreak of COVID-19 progresses, prognostic markers for the identification of high-risk individuals are urgently needed. The angiotensin system is implicated in the pathogenesis of COVID-19 as ACE2 is the cellular receptor for SARS-COV-2 virus, and expression of the ACE2 gene could regulate an individual’s susceptibility to infection. In addition, the balance between ACE and ACE2 activity may play a role in the severity of COVID-19. Aim of work The aim of the work is to explore the role of ACE1 I/D and ACE2 G8790A gene variants and serum ACE l/ACE2 ratio as risk factors for severity of COVID-19 infection. Methods One hundred and eighty COVID-19 patients were divided into three groups: mild (60 patients), moderate (60 patients), and severe (60 patients). The enzyme levels of ACE and ACE2 were measured by ELISA. ACE I/D (rs4646994) was assayed using PCR and ACE2 (rs2285666) gene variant was determined using real-time PCR. Results ACE/ACE2 ratio was significantly lower in the mild group than in the moderate-to-severe group (P 50y) (OR 10.4, 95% CI 3.8–28.4, P 50 years), presence of comorbidities, and a high ACE/ACE2 ratio are recognized as pivotal predictors of COVID-19 severity.

Keywords

• Angiotensin-converting enzyme ACE and ACE2 levels
• ACE gene variants
• COVID-19 severity