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November 22, 2022Scientific ReportsOpen Access

The systemic renin-angiotensin system in COVID-19

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Key result

Severe COVID-19 was associated with elevated angiotensin II levels (114 vs 58 pmol/L) and a significantly lower angiotensin II:I ratio (1.6 vs 2.6) compared to non-severe COVID-19.

Population

159 patients hospitalized with COVID-19, stratified by disease severity (severe, n = 76; non-severe: n = 83)

Design

Cohort

Authors

RRRoman Reindl‐SchwaighoferMedical University of ViennaSHSebastian HödlmoserMedical University of ViennaODOliver DomenigGeneral Cardiology

Discussion

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Implication

Elevated classical RAS metabolites in severe COVID-19 largely reflect RAS inhibitor use; leaves open whether targeted modulation improves outcomes.

Study Design

Type

Observational (n=159)

Multicenter

Yes

Structured PICO

P
Population
159 hospitalized patients with PCR-confirmed COVID-19, stratified by disease severity, followed until discharge or death.
O
Outcome
Key metabolites of the classical RAS (angiotensins I-II) and alt-RAS (angiotensins 1-7 and 1-5) pathways as well as ACE and ACE2 concentrationssurrogate

Main Result

Absolute Event Rate: 114% vs 58%

p-value: p=<0.05

Angiotensin II is elevated in severe COVID-19 but is markedly influenced by RAS inhibitors and driven by overall RAS activation rather than just ACE2 downregulation.

Limitations

  • Observational study design does not allow inferring causal relations.
  • Renin activity was not directly measured but estimated as the sum of key angiotensins (PRA-S).
  • Analysis was limited to key enzymatic pathways of the classical and alternative RAS.
  • The control group of influenza patients lacked longitudinal data.

Cite This Study

Reindl‐Schwaighofer et al. (2022) conducted an observational in COVID-19 (n=159). Severe COVID-19 vs. Non-severe COVID-19 was evaluated on Angiotensin II levels (pmol/L) (p=<0.05). Severe COVID-19 was associated with elevated angiotensin II levels (114 vs 58 pmol/L) and a significantly lower angiotensin II:I ratio (1.6 vs 2.6) compared to non-severe COVID-19.

synapsesocial.com/papers/6ab5e901c21d028cecfb81f4https://doi.org/10.1038/s41598-022-24628-1

Topics

COVID-19 cardiovascular
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