Univariate analysis

Intensive care unit

Critical illness

Critically ill

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Receptor

Angiotensin II

Infectious disease (medical specialty)

Gastroenterology

Disease

Pathogenesis

Severity of illness

Coronavirus disease 2019 (COVID-19)

Blood pressure

Plasma renin activity

Multivariate analysis

Internal medicine

Plasma levels

Renin–angiotensin system

Medicine

Critical Care

Little is known about the mechanism of coronavirus disease 2019 (COVID-19)-induced critical illness and death.The host infection mediated by SARS-CoV-2 is mainly relied on ACE2 receptor.There is still a lack of clinical data about the effects of interaction of ACE2 and SARS-CoV-2 on RAS system and disease progression.We investigated the plasma angiotensin II (Ang II) and renin levels in 82 non-hypertensive patients (42 mild cases, 25 severe cases, and 15 critically ill cases) infected by SARS-CoV-2 and 12 critically ill patients not infected by SARS-CoV-2 serving as control.Plasma Ang II level was higher than that of normal range in the majority of COVID-19 cases (90.2%), especially the plasma Ang II positive rate in the critically ill COVID-19 patients (100%).Plasma Ang II level in critically ill COVID-19 patients was significantly higher than that of control and those with mild COVID-19 symptoms (Fig. 1).Univariate analysis indicated a positive correlation between plasma Ang II level and COVID-19 severity.Partial SARS-CoV-2 patients (12.2%) showed elevation of renin content than normal range.There were no statistical differences in renin among the mild, severe, and

Elevation of plasma angiotensin II level is a potential pathogenesis for the critically ill COVID-19 patients