Respiratory failure & ventilation
Renin–angiotensin–aldosterone system activation in plasma as marker for prognosis in critically ill patients with COVID-19: a prospective exploratory study
Authors' conclusion
AA2R at inclusion predicted 60-day survival with moderate sensitivity, revealing a dissociation between unchanged aldosterone and increased Ang II levels in the most severely ill COVID-19 patients.
Study context
- Population
- Patients with COVID-19 admitted to a medical ward or an ICU
- Participants
- 94 patients
- Outcome
- Renin-angiotensin system (RAS) parameters as predictors of 28-day and 60-day survival
Main finding
As reported in the abstract
AA2R at inclusion predicted 60-day survival in ICU patients (AUROC)
0.73
Angiotensin (Ang) II inversely associated with survival
OR 0.07
95%CI 0.01, 0.39
Active ACE2 inversely associated with survival
OR 0.10
95%CI 0.01, 0.63
Higher Ang 1-7 predicted favorable outcome
OR 6.8
95%CI 1.5, 39.9
Observational data: associations, not effects.
Further findings
ICU vs medical ward patients at inclusion
- ICU patients: higher all angiotensin metabolites, PRA-S, ALT-S and active ACE2; lower ACE-S and AA2R
Change after 7 days in ICU · seven days
- Ang I, Ang II, Ang III and Ang IV decreased; Angiotensin-converting enzyme (ACE) and ACE2 increased
Correlation with SOFA score and driving pressure
- Ang I, PRA-S, Ang 1-7 and Ang 1-5 correlated with SOFA at inclusion and after 7 days, and with driving pressure after 7 days
Original publication
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