{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T09:07:33Z","timestamp":1793869653314,"version":"4.6.1"},"reference-count":16,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T00:00:00Z","timestamp":1629417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objective: Insertion\/deletion polymorphisms of angiotensin-converting enzyme (ACE) have been previously described in association with adult respiratory distress syndrome (ARDS) and correlated to outcome. The ACE deletion\/deletion(D\/D)genotype represents a marker of thrombosis in subjects apparently without predisposing factors and\/or traditional thrombophilic alterations and increases the risk of venous thromboembolism in subjects in whom a thrombogenic condition occurs. Thrombosis seems to play a role very early in the disease caused by SARS-CoV-2, in particular in those with severe COVID-19 pneumonia. The counterbalance between angiotensin-converting enzyme (ACE) and ACE2 activities in COVID-19 disease may play a crucial role in the thrombo-inflammatory process. We hypothesised that a genetic predisposition could condition the severity and complications of SARS-CoV-2 infection. Materials and methods: We conducted a spontaneous, single centre observational study in the Sub-Intensive Care Unit of A.O.R.N. Ospedali dei Colli, Cotugno Hospital, Naples (Italy). In this study, we performed genetic screening for ACE D\/D genotype and other thrombophilic mutations in 20 patients affected by ARDS related to COVID-19 pneumonia, compared to 19 age- and sex-matched healthy controls. Results: All tested patients had multiple polymorphisms and, in particular, a significantly higher prevalence of ACE D\/D polymorphism in severe COVID-19 patients Conclusion: We found that the majority of patients who tested positive for ACE D-D genotype and who were not associated with other risk factors for VTE showed an evolution to ARDS. This finding could have a predicting role in the selection of patients more prone to developing severe COVID-19 during clinical observation in emergency department.<\/jats:p>","DOI":"10.3390\/medicina57080844","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T08:44:45Z","timestamp":1629449085000},"page":"844","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The Angiotensin Converting Enzyme Deletion\/Deletion Genotype Is a Risk Factor for Severe COVID-19: Implication and Utility for Patients Admitted to Emergency Department"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2404-3545","authenticated-orcid":false,"given":"Anna","family":"Annunziata","sequence":"first","affiliation":[{"name":"Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi\u2014A.O. Dei Colli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonietta","family":"Coppola","sequence":"additional","affiliation":[{"name":"Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi\u2014A.O. Dei Colli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Di Spirito","sequence":"additional","affiliation":[{"name":"Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi\u2014A.O. Dei Colli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Cauteruccio","sequence":"additional","affiliation":[{"name":"Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi\u2014A.O. Dei Colli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Marotta","sequence":"additional","affiliation":[{"name":"Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi\u2014A.O. Dei Colli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8484-4598","authenticated-orcid":false,"given":"Pierpaolo Di","family":"Micco","sequence":"additional","affiliation":[{"name":"Department of Medicine, Ospedale Buonconsiglio Fatebenefratelli di Napoli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Fiorentino","sequence":"additional","affiliation":[{"name":"Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation Monaldi\u2014A.O. Dei Colli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1164\/rccm.2108086","article-title":"Angiotensin converting enzyme insertion\/deletion polymorphism is associated with susceptibility and outcome in acute respiratory distress syndrome","volume":"166","author":"Marshall","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s13054-020-02880-z","article-title":"COVID-19 pneumonia: ARDS or not?","volume":"24","author":"Gattinoni","year":"2020","journal-title":"Crit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.coph.2006.03.001","article-title":"Angiotensin-converting enzyme 2 in lung diseases","volume":"6","author":"Kuba","year":"2006","journal-title":"Curr. Opin. 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