The effect of angiotensin-converting enzyme insertion/deletion polymorphism on severity and death rate of COVID-19 in Iranian patients

Abstract

Abstract The study was designed to assess the association of ACE I/D polymorphism with the severity and prognosis of COVID-19 in Iranian population. Hence, 186 adult patients were categorized into three clinical groups based on the severity of COVID-19: 1) Outpatients or mild symptomatic patients as control; 2) Hospitalized patients or severe symptomatic cases; 3) Inpatients led to ICU/death or critically ill patients needed mechanical ventilation. The possible association of ACE I/D polymorphism with the risk of comorbidities and serum level of C-reactive protein was evaluated in two severe cases. The results showed that the frequency of D and I alleles are 69.35% and 30.65%, respectively, in total population. The analysis of allelic frequencies via Fisher's exact test confirmed significantly higher frequency of D allele in both severe groups than that in the mild one, 78.31% in Hospitalized patients (OR = 0.38; 95% CI = 0.22 to 0.68; p-value = 0.0011) and 74.19% in Inpatients led to ICU/death (OR = 0.48; 95% CI = 0.29 to 0.82; p-value = 0.0094) compared to 58.45% in Outpatients. The results of genotype proportions displayed an association between COVID-19 severity and DD genotype. Altogether, our findings in Iranian patients and other reports from different population lead us to the conclusion that despite the undoubted role of the DD genotype in the severity of the disease, the protective effect of the I allele is highly depended on the genetic pool of ethnicities.