title: Angiotensin-converting enzyme (ACE) I/D corrected serum ACE activity and severity assessment of community-acquired pneumonia.
abstract: BACKGROUND
  Various studies have described decreased serum angiotensin-converting enzyme (ACE) activity in patients with pneumonia. The aim of the present study was to evaluate the role of ACE in pneumonia by comparing ACE insertion/deletion (I/D) genotype corrected serum ACE activity and to establish whether the severity of the disease correlates with lower ACE activity.
  
  
  METHODS
  This was a prospective hospital-based observational study including 134 patients with pneumonia. Serum ACE activity was determined at admission, on days 2, 3, 5 and 10 of hospital stay, and at recovery. Based on ACE genotype and reference values, corresponding Z-scores were calculated. Disease severity, quantified by the acute physiology score (APS), and clinical outcome were compared between tertile groups of the Z-scores.
  
  
  RESULTS
  A significant decrease in serum ACE activity during an episode of pneumonia with return to control range during recovery was observed for all three genotypes (II, ID and DD). The calculated Z-scores showed a negative correlation with APS scores (p=0.050). No significant association between decreased serum ACE activity and clinical outcome was observed.
  
  
  CONCLUSIONS
  Serum ACE activity is significantly decreased during the acute phase of pneumonia. Despite correction for ACE I/D genotype, decreased ACE activity did not show a prognostic value. Further studies are needed to examine the mechanisms behind and diagnostic value of decreased ACE activity in community-acquired pneumonia.
authors.affiliation: Department of Clinical Pharmacy, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, The Netherlands. e.van.de.garde@antoniusmesosgroep.nl
authors.forename: Ewoudt M W
authors.initials: EM
authors.lastname: van de Garde
authors.forename: Henrik
authors.initials: H
authors.lastname: Endeman
authors.forename: Vera H M
authors.initials: VH
authors.lastname: Deneer
authors.forename: Douwe H
authors.initials: DH
authors.lastname: Biesma
authors.forename: Henk J T
authors.initials: HJ
authors.lastname: Ruven
authors.forename: Heleen
authors.initials: H
authors.lastname: van Velzen-Blad
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: Jules M M
authors.initials: JM
authors.lastname: van den Bosch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000201:enzymology / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood* / Q000235:genetics; D011014:Pneumonia / Q000175:diagnosis* / Q000201:enzymology / Q000453:epidemiology; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D007703:Peptidyl-Dipeptidase A