# Angiotensin converting enzyme 2 in patients with sepsis associate with comorbidities but neither with mortality nor with organ failure

## TL;DR

The study found that high levels of ACE2 in sepsis patients are linked to comorbidities but not to mortality or organ failure.

## Contribution

This study is the first to show that plasma ACE2 levels in sepsis are not associated with mortality or organ failure despite being linked to comorbidities.

## Key findings

- Plasma ACE2 levels were higher in patients with comorbidities like diabetes, cardiovascular disease, and cancer.
- ACE2 levels were not associated with 28-day mortality or organ failure in sepsis patients.
- ACE2 levels correlated with hospitalization and intermediate care unit stay in univariate analysis but not in multivariate analysis.

## Abstract

High levels of circulating angiotensin converting enzyme 2 (ACE2) are associated with several chronic diseases and mortality risk. Less is known about the prognostic value of ACE2 in patients with sepsis. In the present study, we aimed to investigate the association between plasma ACE2 levels on admission to the ED and 28-day mortality, organ failure, and level of care in a prospectively recruited observational study sample. Six hundred patients with sepsis admitted to the emergency in Malmö 2013–2015 were included in the analysis. Uni- and multivariable binary logistic regression was conducted to investigate the association between ACE2 and 28-day mortality, organ failure, and level of care. Plasma ACE2 levels were increased in patients with male sex, high age, and comorbidities, including diabetes, cardiovascular disease, and cancer. Plasma ACE2 levels associated with hospitalization and intermediate care unit stay in univariate but not multivariate analysis. Plasma ACE2 did neither associate with 28-day mortality, OR 1.19 (95% CI 0.86–1.65, p = 0.29), nor with organ failure, OR 1.08 (95% CI 0.73–1.56. p = 0.72). Future studies investigating the dynamics of circulating ACE2 levels in patients with sepsis longitudinally are warranted.