Soluble Angiotensin-Converting Enzyme 2 as a Prognostic Biomarker for Disease Progression in Patients Infected with SARS-CoV-2

Predicting disease severity in patients infected with SARS-CoV-2 is difficult. Soluble angiotensin-converting enzyme 2 (sACE2) arises from the shedding of membrane ACE2 (mACE2), which is a receptor for SARS-CoV-2 spike protein. We evaluated the predictive value of sACE2 compared with known biomarker...

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Published in:Diagnostics (Basel) 2022-04, Vol.12 (4), p.886
Main Authors: Díaz-Troyano, Noelia, Gabriel-Medina, Pablo, Weber, Stephen, Klammer, Martin, Barquín-DelPino, Raquel, Castillo-Ribelles, Laura, Esteban, Angels, Hernández-González, Manuel, Ferrer-Costa, Roser, Pumarola, Tomas, Rodríguez-Frías, Francisco
Format: Article
Language:English
Subjects:
angiotensin-converting enzyme 2
Biomarkers
Clinical outcomes
Coronaviruses
COVID-19
Cytokines
Disease
disease severity
Emergency medical care
Enzymes
Hospitals
Immune system
Infections
Inflammation
Medical research
Pandemics
Patients
Proteins
SARS-CoV-2
SARS-CoV-2 spike protein
Severe acute respiratory syndrome coronavirus 2
Statistical analysis
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Summary:Predicting disease severity in patients infected with SARS-CoV-2 is difficult. Soluble angiotensin-converting enzyme 2 (sACE2) arises from the shedding of membrane ACE2 (mACE2), which is a receptor for SARS-CoV-2 spike protein. We evaluated the predictive value of sACE2 compared with known biomarkers of inflammation and tissue damage (CRP, GDF-15, IL-6, and sFlt-1) in 850 patients with and without SARS-CoV-2 with different clinical outcomes. For univariate analyses, median differences between biomarker levels were calculated for the following patient groups (classified by clinical outcome): RT-PCR-confirmed SARS-CoV-2 positive (Groups 1−4); RT-PCR-confirmed SARS-CoV-2 negative following previous SARS-CoV-2 infection (Groups 5 and 6); and ‘SARS-CoV-2 unexposed’ patients (Group 7). Median levels of CRP, GDF-15, IL-6, and sFlt-1 were significantly higher in hospitalized patients with SARS-CoV-2 compared with discharged patients (all p < 0.001), whereas levels of sACE2 were significantly lower (p < 0.001). ROC curve analysis of sACE2 provided cut-offs for predicting hospital admission (≤0.05 ng/mL (positive predictive value: 89.1%) and ≥0.42 ng/mL (negative predictive value: 84.0%)). These findings support further investigation of sACE2, as a single biomarker or as part of a panel, to predict hospitalization risk and disease severity in patients with SARS-CoV-2 infection.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics12040886