Polymorphism of the angiotensin-converting enzyme gene affects the outcome of acute respiratory distress syndrome*
- 1 April 2006
- journal article
- editorial
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 34 (4), 1001-1006
- https://doi.org/10.1097/01.ccm.0000206107.92476.39
Abstract
There has been increasing evidence that angiotensin II may play an important role in the pathogenesis and in the evolution of acute lung injury. It was therefore hypothesized that polymorphisms of the angiotensin-converting enzyme gene affects the risk and outcome of acute respiratory distress syndrome (ARDS). Prospective, observational study. The ARDS group consisted of 101 patients treated at the medical intensive care unit; the control groups consisted of 138 “at-risk” patients treated at the medical intensive care unit due to acute respiratory failure but did not meet the ARDS criteria throughout the hospital course, and 210 non–at-risk subjects. None. The ARDS patients and control subjects were genotyped for the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme gene. Association of the polymorphism and the risk and the outcome of ARDS was analyzed. There was no significant difference in the frequencies of the genotypes between the ARDS, at-risk, and non–at-risk groups. The 28-day mortality rates were significantly different between the three angiotensin-converting enzyme genotypes (42%, 65%, and 75% for II, ID, and DD, respectively; p = .036). Survival analysis showed that the II genotype favorably affected 28-day survival (hazard ratio, 0.46; 95% confidence interval, 0.26–0.81; p = .007), whereas ARDS caused by hospital-acquired pneumonia had a negative effect (hazard ratio, 2.34; 95% confidence interval, 1.25–4.40; p = .008). The II genotype (hazard ratio, 0.53; 95% confidence interval, 0.32–0.87; p = .012) and ARDS caused by hospital-acquired pneumonia (hazard ratio, 2.13; 95% confidence interval, 1.24–3.68; p = .006) were also significant prognostic factors for the in-hospital mortality. The angiotensin-converting enzyme I/D polymorphism is a significant prognostic factor for the outcome of ARDS. Patients with the II genotype have a significantly better chance of survival. This study did not show an increased risk for ARDS in Chinese patients with the D allele.Keywords
This publication has 37 references indexed in Scilit:
- Mechanical ventilation in sepsis-induced acute lung injury/acute respiratory distress syndrome: An evidence-based reviewCritical Care Medicine, 2004
- Injury and repair in lung and airwaysCritical Care Medicine, 2003
- Incidence of acute lung injury in the United States*Critical Care Medicine, 2003
- Race and gender differences in acute respiratory distress syndrome deaths in the United States: An analysis of multiple-cause mortality data (1979–1996)*Critical Care Medicine, 2002
- Apoptosis of lung epithelial cells in response to TNF‐α requires angiotensin II generation de novoJournal of Cellular Physiology, 2000
- Targeting the Angiotensin System in Posttransplant Airway ObliterationAmerican Journal of Respiratory and Critical Care Medicine, 2000
- Cloning of Trp1β isoform from rat brain: immunodetection and localization of the endogenous Trp1 proteinAmerican Journal of Physiology-Cell Physiology, 1999
- Reduced mortality in association with the acute respiratory distress syndrome (ARDS)Thorax, 1998
- Angiotensin II Induces Apoptosis of Human Endothelial CellsCirculation Research, 1997
- The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination.American Journal of Respiratory and Critical Care Medicine, 1994