Medical Journal of the Islamic Republic Of Iran

en Soluble ACE2 as a Risk or Prognostic Factor in COVID-19 Patients: A Cross-sectional Study Infectious Disease Infectious Disease Original Research Original Research Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. The first known receptor for this virus in the human body is angiotensin-converting enzyme 2 (ACE2), the same receptor for the SARS virus.    Methods: A total of 38 hospitalized adult (18 years) patients with laboratory or clinically confirmed coronavirus disease 2019 (COVID-19) were identified in the infectious disease ward of Tehran Imam Khomeini hospital complex in this single-center cross-sectional study. A blood sample was taken at the time of hospitalization and a second one was taken 48 hours later. Blood samples are kept frozen at -80 degrees Celsius. After the complete collection of samples, the ACE2 level of the samples was measured using a serum sACE2 detection ELISA kit.  The data were analyzed using SPSS v26. P value of 0.05 was considered statistically significant. An analysis of covariance was performed to examine the mean differences in day 7 serum ACE2 concentration among the 2 groups after adjusting for the baseline serum ACE2 concentration. The 1-way multivariate analysis of variance was used to determine whether there were any differences between independent groups (mechanical ventilation yes/no) on serum ACE2 levels at 3 different times.    Results: The mean age of patients was 64.13 ± 16.49 years, 21 patients (55.3%) were men, 16 patients (42%) were polymerase chain reaction test positive, and 15 patients (39.5%) died. A total of 35 individuals (92.1%) had chest computed tomography images that indicated lung involvement. A comparison of the 2 groups of patients who died and were discharged revealed that serum ACE2 at the first (p=0.033) and third (7th day) measurements were statistically different (p=0.026). Patients had a mean of serum ACE2. The results indicated that the day 7 serum ACE2 concentration did significantly differ between the 2 groups after controlling for the baseline serum ACE2 concentration (p=0.023). The model explained about 73.61% of the variance in the 7-day serum ACE2 concentration. Specifically, after adjusting for the baseline concentration, survived patients had the lowest level of serum ACE2 concentration (1 ± 0.65) on the 7th day compared with the deceased patient group (2.83 ± 1.12).    Conclusion: Soluble ACE2 in the serum of COVID-19 patients who died, later on, was significantly higher than the discharged patients when the samples were taken seven days after admission. It is suggested that serum soluble ACE2 level could be used as a prognostic factor for COVID-19 patients’ outcomes and also their need for mechanical ventilation. SARS-CoV-2, Angiotensin-converting enzyme 2, Polymerase chain reaction, Mechanical ventilation, Prognosis, Mortality 1020 1029 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-7433-2&slc_lang=en&sid=1 Parsa Mohammadi p.mohammadi@tums.student.ac.ir 200319475328460074043 200319475328460074043 No Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran Hesam Aldin Varpaei Akademik.hv@gmail.com 200319475328460074044 200319475328460074044 No College of Nursing, Michigan State University, MI, USA Arash Seifi a-seifi@sina.tums.ac.ir 200319475328460074045 200319475328460074045 No Department of Infectious Diseases, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran Sepideh Zahak Miandoab Sepidee67@yahoo.com 200319475328460074046 200319475328460074046 No Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran Saba Beiranvand Saba.b826@gmail.com 200319475328460074047 200319475328460074047 No Department of Nursing, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Sahar Mobaraki sahar.mobaraki@yahoo.com 200319475328460074048 200319475328460074048 No Department of Nursing, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Mostafa Mohammadi mohammady_mm@tums.ac.ir 200319475328460074049 200319475328460074049 Yes Tehran University of Medical Sciences, General ICU of Imam Khomeini Hospital Complex, Tehran, Iran Alireza Abdollahi alireza.a1345@yahoo.com 200319475328460074050 200319475328460074050 No Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran