Plasma ACE2 predicts outcome of COVID-19 in hospitalized patients

• Published in: PloS one Vol. 16; no. 6; p. e0252799
• Main Authors: Kragstrup, Tue W, Singh, Helene Søgaard, Grundberg, Ida, Nielsen, Ane Langkilde-Lauesen, Rivellese, Felice, Mehta, Arnav, Goldberg, Marcia B, Filbin, Michael R, Qvist, Per, Bibby, Bo Martin
• Format: Journal Article
• Language: English
• Published: San Francisco, CA USA Public Library of Science 04-06-2021; Public Library of Science (PLoS)
• Subjects: Angiotensin converting enzyme; Biology and Life Sciences; Care and treatment; Health aspects; Hospital patients; Medicine and Health Sciences; Patient outcomes; Denmark
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0252799

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to angiotensin converting enzyme 2 (ACE2) enabling entrance of the virus into cells and causing the infection termed coronavirus disease of 2019 (COVID-19). Here, we investigate associations between plasma ACE2 and outcome of COVID-19. This analysis used data from a large longitudinal study of 306 COVID-19 positive patients and 78 COVID-19 negative patients (MGH Emergency Department COVID-19 Cohort). Comprehensive clinical data were collected on this cohort, including 28-day outcomes. The samples were run on the Olink® Explore 1536 platform which includes measurement of the ACE2 protein. High admission plasma ACE2 in COVID-19 patients was associated with increased maximal illness severity within 28 days with OR = 1.8, 95%-CI: 1.4-2.3 (P < 0.0001). Plasma ACE2 was significantly higher in COVID-19 patients with hypertension compared with patients without hypertension (P = 0.0045). Circulating ACE2 was also significantly higher in COVID-19 patients with pre-existing heart conditions and kidney disease compared with patients without these pre-existing conditions (P = 0.0363 and P = 0.0303, respectively). This study suggests that measuring plasma ACE2 is potentially valuable in predicting COVID-19 outcomes. Further, ACE2 could be a link between COVID-19 illness severity and its established risk factors hypertension, pre-existing heart disease and pre-existing kidney disease.