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TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Angiotensin converting enzyme inhibitors (ACEi) can increase ACE2 in human tissues and increase the adhesion of Sars-CoV-2. In our study, we aimed to investigate the relationship between serum ACE level with antihypertensive drugs (especially ACEi) and clinical severity. METHODS: A total of 200 symptomatic Sars-CoV-2 patients who were hospitalized or diagnosed in an outpatient clinic were included in the study. The patients were divided into 4 groups as mild, moderate, severe and very severe. There were 43 patients in the mild, 54 patients in the moderate, 53 patients in the severe, and 50 patients in the very severe patient group. Later, 200 patients were divided into 2 groups as mild-moderate (n:97) and severe-very severe patient group (n:103). Serum ACE, complete blood count, C-reactive protein (CRP), procalcitonin and biochemical analysis were evaluated. The demographic data, comorbidities, medications and symptoms of the patients were recorded. RESULTS: The mean age of mild, moderate, severe and very severe patients was 50.4±21.51, 57.13±14.81, 64.34±13.02, 74.88±11.18 respectively (p <0.05). Males were more in the severe-very severe group than females (p <0.05). Those with at least 1 chronic disease were significantly more likely to be in the severe-very severe group than those in the mild-moderate group (p=0.000*). The rate of hypertension and coronary artery disease (CAD) was higher in patients in the severe-very severe group compared to the mild-moderate group. In the mild-moderate group, the number of those using ACEi was 9 and in the severe-very severe patient group was 21(p =0.028). Mean of serum ACE in the mild-moderate group was 28.12±15.83 IU/L and the severe-very severe group was 22.91±14.53 IU/L (p =0.016). A moderate correlation was found between the severity of the patients and their ACE levels. Patients with hypertension who used ACEi, beta blocker and calcium channel blocker were more in the severe-very severe patient group (p<0.05). This relationship was not seen in the use of ARB. Mean of serum ACE in 30 (15%) patients using ACEi and 170 (85%) patients not using ACEi were 11.8±12.93 IU/L and 27.84±14.5 IU/L respectively (p=0.000*). When 30 patients using ACEi were excluded, the remaining 170 patients were again divided into mild-moderate (n=88) and severe-very severe (n=82) patient groups, the mean serum ACE values were 30.1±15.02 IU/L and 25.41±13.6 IU/L respectively (p=0,035). No significant relationship was found with other antihypertensives. CONCLUSIONS: As a result, it was observed that low serum ACE developed with the use of ACEi. In addition an inverse correlation was observed between serum ACE level and clinical severity of COVID-19. CLINICAL IMPLICATIONS: It was thought that serum ACE level may be useful in predicting clinical progression. DISCLOSURES: No relevant relationships by Imran Hasanoglu, source=Web Response No relevant relationships by H.Canan Hasanoglu, source=Web Response No relevant relationships by Aysegul Karalezli, source=Web Response No relevant relationships by ayse kaya kalem, source=Web Response No relevant relationships by Īsil Ozkocak, source=Web Response No relevant relationships by Ali Mücahit ÜNAL, source=Web Response No relevant relationships by Esra YAKISIK CAKIR, source=Web Response