الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 170 |  |  |
| | | from | 170 | | |
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a newly discovered RNA betacoronavirus infection. It has been caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Angiotensin II (Ang II) is a mitochondrial toxin that under normal circumstances is rapidly removed by angiotensin converting enzyme 2 (ACE-2) which converts it into angiotensin 1-7. SARS-CoV-2 uses the receptor ACE-2 for host cell entry and viral replication. ACE-2 downregulation has been directly linked to the critical pulmonary pathology, suggesting that over expression of Ang II acts as an endogenous toxin. Accumulating Ang-II triggers many severe and fatal conditions such as acute respiratory distress syndrome (ARDS).
Aim of the work: To assess the serum level of Ang II and correlate it with the severity of COVID-19 infection in pediatric patients.
Patients and Methods: This case control study was conducted on 45 positive COVID-19 RT-PCR children who were compared to age and sex matched 45 healthy controls. Clinical examination, laboratory assays and imaging studies were done for the patients group to assess the severity of COVID–19 infection. Serum Ang II was measured by ELISA for both groups and correlated with clinical (heart rate, blood pressure, respiratory rate and oxygen saturation), laboratory (total leucocytic count, lymphocytes, neutrophils, serum ferritin, ESR and CRP) and radiological (chest x-ray and CORAD score of CT chest) parameters of the patients.
Results: The median ”IQR” of serum Ang II was statistically significant higher in the COVID-19 patients than in the controls (100 (88-137) ng/L) versus 20 (15-25) ng/L) (p-value= 0.001). There were statistically significant positive correlations between serum Ang II levels and different grades of clinical severity classification (rs=0.92, p-value=0.001) and CORAD score of CT chest. On the other hand, no statistically significant correlations were found between serum levels of Ang II and total leucocytic count, lymphocytes, neutrophils, ESR and CRP.
Conclusion: We concluded that early measurement of serum levels of
Ang II in confirmed COVID-19 children could be a useful diagnostic and prognostic biomarker for identifying patients at higher risk for extremely severe progression of the disease.