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

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.