The Relationship between Soluble Angiotensin-Converting Enzyme Level and Coronavirus Disease 2019 in Children: A Prospective Cohort Study

Objective Our objective was to investigate soluble angiotensin-converting enzyme (sACE) levels in pediatric patients with coronavirus disease 2019 (COVID-19) and to identify factors associated with the occurrence and severity of pediatric COVID-19.

Methods This was a prospective cohort study conducted between April 2020 and July 2020. The study population consisted of 143 children (between 1 month and 18 years old), 103 of whom had COVID-19 and 40 of whom were negative for COVID-19 (randomly selected). The sACE levels and other laboratory data of all participants were measured at admission (day 0, baseline). Repeat measurements were performed in patients on the 5th day. Disease severity was documented at baseline and on the 5th day, and the change in severity between these time points was recorded.

Results Age and sex distribution were similar in the two groups. At baseline, 31 (30.1%) of the patients were asymptomatic, 58 (56.3%) had mild disease, and 14 (13.6%) had moderate disease. Baseline sACE levels were similar in the groups (p = 0.120). Higher weight was independently associated with low sACE levels in children (p = 0.037). The sACE level of patients on the 5th day was significantly lower compared with baseline (p = 0.007). Patients who experienced a decrease in disease severity were compared with those who did not demonstrate a decrease. Baseline sACE levels were significantly lower in those who experienced decreased severity (p = 0.039). Multiple linear regression revealed that COVID-19 severity at baseline was independently associated with the low sACE level at baseline (p = 0.023).

Conclusion Lower sACE at diagnosis was associated with COVID-19 severity in children. However, no strong evidence was found that could suggest the sACE level as an important predictor for the occurrence or severity of COVID-19 in children.