The objective of this research was to assess gene expression levels of ACE2, TMPRSS2, and LZTFL1 in COVID-19 patients from Egypt and investigate their potential association with the severity of the illness. The study involved ninety-six participants, divided into two groups: individuals experiencing severe COVID-19 symptoms and those with milder manifestations. Quantitative polymerase chain reaction (qRT-PCR) was employed to determine the gene expression levels of ACE2, TMPRSS2, and LZTFL1.
In the mild cases, the median age was 35 years, with an age range of 30-41 years, while severe cases had a median age of 65 years, ranging from 58 to 72 years. The male-to-female ratio in the entire group was 47.9% to 52.1%. All participants tested positive for COVID-19 based on nasal swab qPCR tests. Severe cases exhibit a significantly higher mean age. Comorbidities like type 2 diabetes (T2DM) and hypertension are markedly more prevalent in severe cases, while the absence of comorbidities is significantly associated with mild cases. The initial expression levels of all the examined genes were notably higher in severe COVID-19 patients compared to those with mild symptoms. The statistical significance was reflected in the p-values, which were less than 0.001 for ACE2, 0.05 for TMPRSS2, and 0.002 for LZTFL1. ROC curves were employed. The results showed that ACE2 exhibited greater sensitivity (89.58%) and specificity (79.17%) in predicting severe COVID-19 in comparison to LZTFL1 (70.83%) and TMPRSS2 (60.42%). These results propose that ACE2 expression may serve as a profitable prognostic marker for COVID-19.