The Impact of Severe Covid-19 in Iraqi Patients on Serum Angiotensin-Converting Enzyme-2 Level and other Various Diagnosis Biomarkers

Authors

  • Suzan Haleem Kamel Department of Chemistry and Biochemistry, College of Medicine, University of Kerbala, Kerbala, Iraq
  • Fadhil Jawad Al-Tu'ma Department of Chemistry and Biochemistry, College of Medicine, University of Kerbala, Kerbala, Iraq
  • Riyadh Mohi Al-Saegh Section of Nephrology, Department of Internal Medicine, College of Medicine, University of Kerbala, Kerbala, Iraq.

DOI:

https://doi.org/10.22317/imj.v7i4.1263

Keywords:

Covid-19, ACE 2, Ferritin, LDH and CRP

Abstract

Background: The coronavirus disease 2019 (Covid-19) outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Angiotensin-converting enzyme 2 (ACE-2) was rapidly identified as the critical functional receptor for SARS-CoV-2. ACE2 is well-known as a counter-regulator of the renin-angiotensin system (RAS) and plays a key role in the cardiovascular system. Given that ACE-2 functions as both a SARS-CoV-2 receptor and a RAS modulator, the treatment for Covid-19 presents a dilemma of how to limit virus entry but protect ACE-2 physiological functions. These will contribute to a deeper understanding of the complex mechanisms of underlying the relationship between the virus, ACE-2, and severity of disease provide guidance for virus intervention strategies.

Aim:  To study the effect of Covid-19 on the levels of some biomarker such as liver enzyme, ferritin, LDH, CRP and ACE-2 activity levels, and their relations with the severity of Covid-19 and the activity levels of angiotensin converting enzyme-2.

Materials and Methods: This case-control study was conducted on 176 male subjects who diagnosed by physician and were divided into three groups: 59 of them were infected with severe covid-19, 54 of them were infected with moderate covid-19 and 63 of them were checked and obtained as apparently healthy control. Severe and moderate patients were collected from Al-Hayat tertiary center at Al-Hussein Medical City, Kerbala Health Directorates, Kerbala – Iraq during April, 2020- June, 2021 with matched age ranged between (23-88) years. In this study, the levels of  ACE-2 was measured through enzyme-linked immunosorbent assays (ELISA) in sera from healthy volunteers as a control group, and patients with moderate Covid-19, patients with severe Covid-19. Anthropometric, biochemical data were analyzed and then measuring the levels of some biomarker such as liver enzyme, ferritin, LDH, and CRP activity levels.

Results: The levels of ACE-2 were differing significantly among groups. However, the level of CRP, Ferritin and LDH were significantly higher in moderate Covid-19 and severe cases of Covid-19 groups compared to control indicating it to be an dependent predictor in the coronavirus disease and prognosis of disease. In contrast the severe infection was correlated with the age and chronic diseases such as pretention and T2DM.

References

Lu, H., Stratton, C. W., et al. (2020). Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. Journal of medical virology, 92(4), 401.

Hui, D. S., Azhar, E. I., Madani, T. A., Ntoumi, F., Kock, R., Dar, O., et al. (2020). The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China. International journal of infectious diseases, 91, 264–266.

Gorbalenya, A. E., Baker, S. C., Baric, R., Groot, R. J. D., Drosten, C., Gulyaeva, et al. (2020). Severe acute respiratory syndrome-related coronavirus: The species and its viruses–a statement of the Coronavirus Study Group.

Burki, T. K. (2020). Coronavirus in China. Lancet Respir. Med. 8 (3), 238.

World Health Organization. (2020). Coronavirus disease (COVID-19), 12 October 2020.

Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet, 395(10223), 497–506.

Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., et al. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet, 395(10223), 507–513.

Murray, J. F., Matthay, M. A., Luce, J. M., & Flick, M. R. (1988). An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis, 138(3), 720–723.

Mohsin H. S., Ali H. A. , and Al-Tu’ma F. J. (2021) Assessment of von Willebrand actor/ADAMTS13 Ratio and Vitamin K Levels as Predictor Markers for Severity of COVID-19 Patients. JOCMS, (In press).

Zhou, P., Yang, X. L., Wang, X. G., Hu, B., Zhang, L., Zhang, W., et al. (2020). A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 579(7798), 270–273.

Liang, W. H., Guan, W. J., Li, C. C., Li, Y. M., Liang, H. R., Zhao, Y., et al. (2020). Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. The European respiratory journal, 55(6), 2000562.

Vargas-Vargas M, Cortés-Rojo C. Ferritin levels and COVID-19 (2020). Rev Panam Salud Publica. 44:e72.

Kernan, K. F. and Carcillo, J. A. (2017). Hyperferritinemia and inflammation. International immunology, 29(9), 401–409.

Wu, C., Chen, X., Cai, Y., Zhou, X., Xu, S., Huang, H., et al. (2020). Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine, 180(7), 934–943.

Wang, Y., Wang, Y., Chen, Y., Qin, Q. (2020). Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID‐19) implicate special control measures. Journal of medical virology, 92(6), 568–576.

Sun, L., Shen, L., Fan, J., Gu, F., Hu, M., An, Y., et al. (2020). Clinical features of patients with coronavirus disease 2019 from a designated hospital in Beijing, China. Journal of medical virology, 92(10), 2055–2066.

Ji, D., Zhang, D., Chen, Z., Xu, Z., Zhao, P., Zhang, M., et al. (2020). Clinical characteristics predicting progression of COVID-19.

Henry, B. M., De Oliveira, M. H. S., Benoit, S., Plebani, M., & Lippi, G. (2020). Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clinical Chemistry and Laboratory Medicine (CCLM), 58(7), 1021–1028.

Zhao, S., Lin, Q., Ran, J., Musa, S. S., Yang, G., Wang, W., et al. (2020). Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. International journal of infectious diseases, 92, 21–217.

Wang, C., Horby, P. W., Hayden, F. G., et al. (2020). A novel coronavirus outbreak of global health concern. The lancet, 395(10223), 470–473.

Tan, C., Huang, Y., Shi, F., Tan, K., Ma, Q., Chen, Y., et al. (2020). C‐reactive protein correlates with computed tomographic findings and predicts severe COVID‐19 early. Journal of medical virology, 92(7), 856–862.

Deng, Y., Liu, W., Liu, K., Fang, Y. Y., Shang, J., Zhou, L., et al. (2020). Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chinese medical journal, 133(11), 1261.

Li, J., Wang, X., Chen, J., Zhang, H.,et al. (2020). Association of reninangiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China. JAMA cardiology, 5(7), 825–830.

Guan, W. J., Ni, Z. Y., Hu, Y., Liang, W. H., Ou, C. Q., He, J. X., et al. (2020). Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine, 382(18), 1708–1720.

Povoa, P., Pereira, J., and Coelho, L. (2009). C-reactive protein: structure, synthesis and function. C-Reactive Protein: New Research, 307–324.

Sahu, B. R., Kampa, R. K., Padhi, A., et al. (2020). C-reactive protein: a promising biomarker for poor prognosis in COVID-19 infection. Clinica chimica acta, 509, 91–94.

Liu, W., Zhang, Q. I., Chen, J., Xiang, R., Song, H., Shu, S., et al. (2020). Detection of Covid-19 in children in early January 2020 in Wuhan, China. New England Journal of Medicine, 382(14), 1370–1371.

Jothimani, D., Venugopal, R., Abedin, M. F., Kaliamoorthy, I.,et al. (2020). COVID-19 and the liver. Journal of hepatology, 73(5), 1231–1240.

Schaefer, E. A., Arvind, A., Bloom, P. P., et al. (2020). Interrelationship between coronavirus infection and liver disease. Clinical Liver Disease, 15(5), 175.

Lippi, G., & Plebani, M. (2020). Laboratory abnormalities in patients with COVID-2019 infection. Clinical Chemistry and Laboratory Medicine (CCLM), 58(7), 1131–1134.

Martinez-Outschoorn, U. E., Prisco, M., Ertel, A., Tsirigos, A., Lin, Z., Pavlides, S., et al. (2011). Ketones and lactate increase cancer cell “stemness,” driving recurrence, metastasis and poor clinical outcome in breast cancer: achieving personalized medicine via Metabolo-Genomics. Cell cycle, 10(8), 1271–1286.

Erez, A., Shental, O., Tchebiner, J. Z., Laufer-Perl, M., Wasserman, A., Sella, T., et al. (2014). Diagnostic and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med Assoc J, 16(7), 439–43.

Holt, A., Gislason, G. H., Schou, M., Zareini, B., Biering-Sørensen, T., Phelps, M., et al. (2020). New-onset atrial fibrillation: incidence, characteristics, and related events following a national COVID-19 lockdown of 5.6 million people. European heart journal, 41(32), 3072–3079.

Connors, J. M., Levy, J. H. (2020). COVID-19 and its implications for thrombosis and anticoagulation. Blood, The Journal of the American Society of Hematology, 135(23), 2033–2040.

Singh, N., Tang, Y., Zhang, Z., Zheng, C. (2020). COVID-19 waste management: Effective and successful measures in Wuhan, China. Resources, conservation, and recycling, 163, 105071.

Onder, G., Rezza, G., Brusaferro, S. (2020). Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. Jama, 323(18), 1775–1776.

Bhatraju, P. K., Ghassemieh, B. J., Nichols, M., Kim, R., Jerome, K. R., Nalla, A. K., et al. (2020). Covid-19 in critically ill patients in the Seattle region—case series. New England Journal of Medicine, 382(21), 2012–2022.

Guo, L., Ren, L., Yang, S., Xiao, M., Chang, D., Yang, F., et al. (2020). Profiling early humoral response to diagnose novel coronavirus disease (COVID-19). Clinical infectious diseases, 71(15), 778–785.

Takeda, H., Farsiu, S., et al. (2007). Kernel regression for image processing and reconstruction. IEEE Transactions on image processing, 16(2), 349–366.

Iacobellis, G. (2020). COVID-19 and diabetes: can DPP4 inhibition play a role?. Diabetes research and clinical practice, 162.

Kaur, G., Yogeswaran, S., Muthumalage, T., Rahman, I. (2021). Persistently increased systemic ACE2 activity is associated with an increased inflammatory response in smokers with COVID-19. Frontiers in Physiology, 12, 653045.

Seys, L. J., Widagdo, W., Verhamme, F. M., Kleinjan, A., Janssens, W., Joos, G. F., et al. (2018). DPP4, the Middle East respiratory syndrome coronavirus receptor, is upregulated in lungs of smokers and chronic obstructive pulmonary disease patients. Clinical Infectious Diseases, 66(1), 45–53.

Huttunen, R., Heikkinen, T. and Syrjänen, J. (2011). Smoking and the outcome of infection. Journal of internal medicine, 269(3), 258–269.

Han, L., Ran, J., Mak, Y. W., Suen, L. K. P., Lee, P. H., Peiris, J. S. M., et al. (2019). Smoking and influenza-associated morbidity and mortality: a systematic review and meta-analysis. Epidemiology, 30(3), 405–417.

Lippi, G., Henry, B. M. (2020). Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). European journal of internal medicine, 75, 107–108.

Farsalinos, K., Barbouni, A. and Niaura, R. (2020). Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?. Internal and emergency medicine, 15(5), 845–852.

Zhao, S., Lin, Q., Ran, J., Musa, S. S., Yang, G., Wang, W., et al. (2020). Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. International journal of infectious diseases, 92, 214–217.

Alqahtani, J. S., Oyelade, T., Aldhahir, A. M., Alghamdi, S. M., Almehmadi, M., Alqahtani, A. S., et al. (2020). Prevalence, severity and mortality associated with COPD and smoking in patients with COVID-19: a rapid systematic review and meta-analysis. PloS one, 15(5), e0233147.

Patanavanich, R., Glantz, S. A. (2020). Smoking is associated with COVID-19 progression: a meta-analysis. Nicotine and tobacco research, 22(9), 1653–1656.

Grundy, E. J., Suddek, T., Filippidis, F. T., Majeed, A., Coronini-Cronberg, S. (2020). Smoking, SARS-CoV-2 and COVID-19: A review of reviews considering implications for public health policy and practice. Tobacco induced diseases, 18.

Kamel, S. H., Al-Tu’ma, F. J., Al-Saegh, R. M. (2021). Angiotensin-Converting Enzyme Receptor Genotype and its Activity Level as Potential Predictors of the Severity COVID-19 among Iraqi Patients. Journal of Contemporary Medical Sciences, 76(6).

Reddy, R. K., Charles, W. N., Sklavounos, A., Dutt, A., Seed, P. T., Khajuria, A. (2021). The effect of smoking on COVID‐19 severity: A systematic review and meta‐analysis. Journal of medical virology, 93(2), 1045–1056.

Downloads

Published

2024-01-03

How to Cite

1.
Haleem Kamel S, Jawad Al-Tu'ma F, Mohi Al-Saegh R. The Impact of Severe Covid-19 in Iraqi Patients on Serum Angiotensin-Converting Enzyme-2 Level and other Various Diagnosis Biomarkers. Iraq Med J [Internet]. 2024 Jan. 3 [cited 2024 Nov. 23];7(4). Available from: https://iraqmedj.org/index.php/imj/article/view/1263