# Angiopoietins as Predictor Indexes in COVID-19 Patients in Delta and Omicron Waves

## TL;DR

This study shows that the ratio of Angiopoietin-2 to Angiopoietin-1 can help predict the severity of COVID-19 and guide treatment decisions.

## Contribution

The study introduces the Ang-2/Ang-1 ratio as a novel biomarker for predicting disease severity in COVID-19 patients.

## Key findings

- The Ang-2/Ang-1 ratio significantly differed among outpatient, non-ICU, and ICU patient groups.
- The ratio outperformed individual Ang-1 and Ang-2 levels in predicting disease severity.
- An optimal threshold for the ratio was identified to distinguish between patient severity groups.

## Abstract

This study aimed to explore the correlation between Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2) concentrations and the Angiopoietin-2/Angiopoietin-1 ratio (Ang-2/Ang-1) with clinical outcomes, potentially serving as disease severity and survival biomarkers. A study at AHEPA University Hospital involved 90 Coronavirus Disease 2019 (COVID-19) adult patients, 30 hospitalized intensive care units (ICU), 30 inward units (non-ICU), and 30 asymptomatic non-hospitalized individuals as controls. Estimated endothelial dysfunction markers related to angiogenesis were measured. There was a statistically significant difference only between outpatient and hospitalized patients (non-ICU–ICU groups) for the Ang-1 and Ang-2 indices. The Ang-2/Ang-1 ratio has differed significantly among the individual patient groups. An ROC analysis was conducted to find an optimal threshold for distinguishing between (outpatients–non-ICU) and (non-ICU–ICU) groups. It was based on Youden’s index of 0.1122 and 0.3825, respectively. The Ang-1, Ang-2 levels, and Ang-2/Ang-1 ratio were analyzed as severity indicators in COVID-19 patients. The Ang-2/Ang-1 ratio demonstrated better prognostic and diagnostic utility than individual biomarker levels. Monitoring the Ang-2/Ang-1 ratio can identify COVID-19 patients at risk and assist clinicians in tailoring treatment strategies to improve outcomes.