Efficacy of Serum Angiotensin II Levels in Prognosis of Patients With Coronavirus Disease 2019

Abstract

OBJECTIVES: We aimed to determine serum angiotensin II levels in patients with coronavirus disease 2019 infection and to investigate the effect of these levels on the prognosis of the disease. DESIGN: The study was planned prospectively and observationally. SETTING: The study was conducted in a tertiary university hospital. PATIENTS: Coronavirus disease 2019 patients older than 18 years old, polymerase chain reaction test positive, with signs of pneumonia on tomography, and hospitalized were included in the study. ICU need, development of acute respiratory distress syndrome, and in-hospital mortality were considered as primary endpoints. INTERVENTIONS: Blood samples were taken from patients three times for angiotensin II levels. MEASUREMENTS AND MAIN RESULTS: Angiotensin II levels were studied by enzyme-linked immunosorbent assay method. The SPSS 24.0 program (Statistics Program for Social Scientists, SPSS, Chicago, IL) was used to analyze the data. A total of 112 patients were included in the study, of which 63.4% of the patients were men. The serum angiotensin II levels were statistically significantly lower in the patients with coronavirus disease 2019 compared with the healthy control group (p < 0.001). There was no statistical significance between the serum angiotensin II levels measured at three different times (p > 0.05). The serum angiotensin II levels of the patients with acute respiratory distress syndrome were found to be statistically significantly lower than those without acute respiratory distress syndrome in three samples collected at different clinical periods (p < 0.05). The angiotensin II levels of the patients who required admission to the ICU at all three times of blood sample collection were found to be statistically significantly lower than those who did not (p < 0.05). Although the serum angiotensin II levels of the patients who died were low, there was no statistically significant difference in mortality at all three times (p > 0.05). CONCLUSIONS: The serum angiotensin II levels decrease significantly in patients with coronavirus disease 2019, and this decrease is correlated with lung damage.

Pathophysiology of COVID-19-associated acute kidney injury

“…This association is also observed in other critical care settings, such as distributive shock or cardiac surgery as a consequence of a relative deficit of angiotensin II, which induces renin release via a positive-feedback loop 129 , 130 . The existence of a similar mechanism in COVID-19 is suggested by the presence of lower angiotensin II levels in patients with COVID-19 and ARDS than in patients with milder disease 131 .…”

Quantifying Renin-Angiotensin-System Alterations in COVID-19

“…The meta-analysis that we carried out in the previous section has shed some light on these questions to a certain extent, but many points remain obscure. Indeed, the experimental and clinical data that we collected from the literature about e.g., the levels of proteins and peptides involved in RAS and the activity of the enzymes, partially disagree [79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94].…”

“…We review here recent data about measurements of RAS components in COVID-19. For that purpose, we manually collected and screened a series of clinical and experimental results from [79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94], listed in Supplementary Table S1. The individuals enrolled in these studies were classified into two or three classes: COVID-19 patients or severe and moderate COVID-19 patients, and controls or asymptomatic patients.…”

The Right Ventricle in COVID-19

“…These observations suggest that severe COVID-19 is associated with global RAS dysregulation but not simply with a skewed balance in favor of ACE1 activity. This might reflect a global reduction of ACE1 and ACE2 expression in the damaged lung [103,104], a hypothesis which will deserve confirmation.…”

“…The role of ACE1/ACE2 imbalance and ATII signaling in COVID-19 remains, however, to be clarified. Indeed, while early data indicated a positive correlation between circulating ATII levels and the severity of the disease [102], two recent studies reported contrasting results with lower circulating ATII in non-survivors [103,104]. These observations suggest that severe COVID-19 is associated with global RAS dysregulation but not simply with a skewed balance in favor of ACE1 activity.…”