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. 2023 Jun 6:17:11795484231180391.
doi: 10.1177/11795484231180391. eCollection 2023.

Impact of the Angiotensin-Converting Enzyme (ACE) Inhibitors on the Course of the Acute Respiratory Distress Syndrome (ARDS) Developed During COVID-19 and Other Severe Respiratory Infections Under Hyperferritinemia Conditions: A Cohort Study

Magda Rurua  1 , Elena Pachkoria  1 , Tamar Sanikidze  2 , K Machvariani  1 , George Ormocadze  3 , Tinatin Jomidava  1 , Diana Dzidziguri  4 , Levan Ratiani  1
Affiliations

Impact of the Angiotensin-Converting Enzyme (ACE) Inhibitors on the Course of the Acute Respiratory Distress Syndrome (ARDS) Developed During COVID-19 and Other Severe Respiratory Infections Under Hyperferritinemia Conditions: A Cohort Study

Magda Rurua et al. Clin Med Insights Circ Respir Pulm Med. .

Abstract

Background: Angiotensin-converting enzyme 2 (ACE2) is not only the entry route of SARS-CoV-2 infection but also triggers a major mechanism of COVID-19 aggravation by promoting a hyperinflammatory state, leading to lung injury, hematological and immunological dysregulation. The impact of ACE2 inhibitors on the course of COVID-19 is still unclear. The effect of ACE2 inhibitors on the course of acute respiratory distress syndrome (ARDS) during COVID-19 and other severe respiratory infections in conditions of hyperferritinemia (HF) was investigated.

Methods: A cohort study of critically ill patients with COVID-19 and other respiratory diseases (widespread infection, pneumonia) who underwent treatment in The Critical Care Unit of the First University Clinic (Tbilisi, Georgia) during the 2020-2021 years was conducted. The impact of the ACE2 inhibitors on the course of the ARDS developed during COVID-19 and other severe respiratory infections in conditions of different severity of HF was evaluated.

Results: In COVID-19-infected (I) and uninfected (II) patients with ARDS, ACE2 inhibitors reduce the levels of Ang II, C reactive protein (CRP) and D-dimer (I: from 1508.07 ± 26.68 to 48.51 ± 24.35, from 233.92 ± 13.02 to 198.12 ± 11.88, from 7.88 ± 0.47 to 6.28 ± 0.43; II: from 1000.14 ± 149.49 to 46.23 ± 88.21, 226.48 ± 13.81 to 183.52 ± 17.32, from 6.39 ± 0.58 to 5.48 ± 0.69) at moderate HF and Ang II, CRP levels (I: from 1845.89 ± 89.37 to 49.64 ± 51.05, from 209.28 ± 14.41 to 175.37 ± 9.84; II: from 1753.29 ± 65.95 to 49.76 ± 55.74, 287.10 ± 20.50 to 214.71 ± 17.32) at severe HF, reduce interleukin-6 (IL-6) expression at moderate HF (I: from 1977.23 ± 354.66 to 899.36 ± 323.76) and cause reduction of pCO2 index at severe HF (I: from 69.80 ± 3.22 to 60.44 ± 2.20) in COVID-19-infected patients.

Conclusion: Study results show that the ACE2 inhibitors play an important role in the regulation of inflammatory processes in both COVID-19-infected and uninfected patients with ARDS. ACE2 inhibitors decrease immunological disorders, inflammation, and lung alveoli dysfunction, especially in COVID-19-infected patients.

Keywords: ACE2 inhibitors; COVID-19; hyperferritinemia; respiratory infections.

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Figures

Figure 1.
Figure 1.
Angiotensin II levels (control level: 31.25-2000pg/mL) in COVID-19-infected and uninfected patients with (1) or without (2) prior ACE2 inhibitors use (A - ferritin level <1500 ng/mL; B - ferritin level >1500 ng/mL) (Δ- COVID-19-infected patients; ◊ - COVID-19-uninfected patients).
Figure 2.
Figure 2.
Leukocyte levels (control level: 4.00–11.00  ×  109/L) in COVID-19-infected and uninfected patients with (1) or without (2) prior ACE2 inhibitors use (A - ferritin level <1500ng/mL; B - ferritin level >1500ng/mL). (Δ-COVID-19-infected patients; Δ - COVID-19-uninfected patients).
Figure 3.
Figure 3.
Levels of IL-6 (control level: 1000–7000pg/μL) in COVID-19-infected and uninfected patients with (1) or without (2) prior ACE inhibitors use (A - ferritin level <1500ng/mL; B - ferritin level >1500ng/mL). (Δ- COVID-19-infected patients; ◊ - COVID-19-uninfected patients).
Figure 4.
Figure 4.
Platelets count (control level: 150–380  ×  103µL) in COVID-19-infected and uninfected patients with (1) or without (2) prior ACE2 inhibitors use (A - ferritin level <1500ng/mL; B - ferritin level >1500ng/mL). ( Δ- COVID-19-infected patients; ◊ - COVID-19-uninfected patients).
Figure 5.
Figure 5.
D-dimer level (control level: 0.10–0.50mg/L) in COVID-19-infected and uninfected patients with (1) or without (2) prior ACE2 inhibitors use (A - ferritin level <1500ng/mL; B - ferritin level >1500ng/mL). ( Δ- COVID-19-infected patients; ◊ - COVID-19-uninfected patients).
Figure 6.
Figure 6.
CRP levels (control level: < 5mg/L) in COVID-19-infected and uninfected patients with (1) or without (2) prior ACE2 inhibitors use (A - ferritin level <1500ng/mL; B - ferritin level >1500ng/mL). (Δ- COVID-19-infected patients; ◊ - COVID-19-uninfected patients).
Figure 7.
Figure 7.
pCO2 levels (control level: 32–45mm Hg) in COVID-19-infected and uninfected patients with (1) or without (2) prior use of ACE2 inhibitors (A - ferritin level <1500ng/mL; B - ferritin level >1500ng/mL)). (Δ- COVID-19 infected patients; ◊ - COVID-19-uninfected patients).
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References

    1. Diamond M, Peniston HL, Sanghavi D, Mahapatra S.Acute Respiratory Distress Syndrome. Last Update: October 30, 2022. - PubMed
    1. Matthay MA, Zemans RL, Zimmerman GA, et al.Acute respiratory distress syndrome. Nat Rev Dis Primers. 2019;5(1):18. - PMC - PubMed
    1. Krynytska I, Marushchak M, Birchenko I, Dovgalyuk A, Tokarskyy O.COVID-19-associated acute respiratory distress syndrome versus classical acute respiratory distress syndrome (a narrative review). Iran J Microbiol. 2021;13(6):737‐747. - PMC - PubMed
    1. Dmytriw AA, Chibbar R, Chen PPYet al.Outcomes of acute respiratory distress syndrome in COVID-19 patients compared to the general population: A systematic review and meta-analysis. Expert Rev Respir Med. 2021;15(10):1347‐1354. - PMC - PubMed
    1. Atri D, Siddiqi HK, Lang JP, Nauffal V, Morrow DA, Bohula EA.COVID-19 for the cardiologist: Basic virology, epidemiology, cardiac manifestations, and potential therapeutic strategies. Basic to Translational Science .2020;5:518‐536. - PMC - PubMed