Kassif Lerner Reut, Stein Yeshurun Michal, Hemi Rina, Zada Nahid, Asraf Keren, Doolman Ram, Benoit Stefanie W, Santos de Oliveira Maria Helena, Lippi Giuseppe, Henry Brandon Michael, Pessach Itai M, Pode Shakked Naomi
Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
J Pers Med. 2022 Apr 12;12(4):622. doi: 10.3390/jpm12040622.
One of the major challenges for healthcare systems during the Coronavirus-2019 (COVID-19) pandemic was the inability to successfully predict which patients would require mechanical ventilation (MV). Angiotensin-Converting Enzyme 2 (ACE2) and TransMembrane Protease Serine S1 member 2 (TMPRSS2) are enzymes that play crucial roles in SARS-CoV-2 entry into human host cells. However, their predictive value as biomarkers for risk stratification for respiratory deterioration requiring MV has not yet been evaluated. We aimed to evaluate whether serum ACE2 and TMPRSS2 levels are associated with adverse outcomes in COVID-19, and specifically the need for MV. COVID-19 patients admitted to an Israeli tertiary medical center between March--November 2020, were included. Serum samples were obtained shortly after admission (day 0) and again following one week of admission (day 7). ACE2 and TMPRSS2 concentrations were measured with ELISA. Of 72 patients included, 30 (41.6%) ultimately required MV. Serum ACE2 concentrations >7.8 ng/mL at admission were significantly associated with the need for MV (p = 0.036), inotropic support, and renal replacement therapy. In multivariate logistic regression analysis, elevated ACE2 at admission was associated with the need for MV (OR = 7.49; p = 0.014). To conclude, elevated serum ACE2 concentration early in COVID-19 illness correlates with respiratory failure necessitating mechanical ventilation. We suggest that measuring serum ACE2 at admission may be useful for predicting the risk of severe disease.
在2019冠状病毒病（COVID-19）大流行期间，医疗系统面临的主要挑战之一是无法成功预测哪些患者需要机械通气（MV）。血管紧张素转换酶2（ACE2）和跨膜丝氨酸蛋白酶2（TMPRSS2）是在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）进入人类宿主细胞过程中起关键作用的酶。然而，它们作为预测需要MV的呼吸功能恶化风险分层生物标志物的价值尚未得到评估。我们旨在评估血清ACE2和TMPRSS2水平是否与COVID-19的不良结局相关，特别是与MV需求相关。纳入了2020年3月至11月期间入住以色列一家三级医疗中心的COVID-19患者。入院后不久（第0天）和入院一周后（第7天）再次采集血清样本。用酶联免疫吸附测定法（ELISA）测量ACE2和TMPRSS2浓度。在纳入的72例患者中，30例（41.6%）最终需要MV。入院时血清ACE2浓度>7.8 ng/mL与MV需求（p = 0.036）、血管活性药物支持和肾脏替代治疗显著相关。在多因素逻辑回归分析中，入院时ACE2升高与MV需求相关（比值比[OR]=7.49；p = 0.014）。总之，COVID-19疾病早期血清ACE2浓度升高与需要机械通气的呼吸衰竭相关。我们建议入院时检测血清ACE2可能有助于预测严重疾病的风险。
