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Eur Respir J 2006, doi:10.1183/09031936.00046106
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ORIGINAL ARTICLE |
ACE I/D but not AGT (-6)A/G polymorphism is a risk factor for mortality in ARDS
1 Institut für Pharmakogenetik, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, FRG; and Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, FRG
2 Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, FRG
3 Institut für Pharmakogenetik, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, FRG
* To whom correspondence should be addressed. E-mail: michael.adamzik{at}uni-essen.de.
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Abstract |
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The intrapulmonary Renin-Angiotensin-System via tissue concentration of angiotensin II or bradykinin may have multiple effects on pulmonary pathophysiology. Therefore, we investigated, whether the presence of the D allele of the ACE I/D polymorphism or the A allele of angiotensinogen (AGT) promoter polymorphism (-6)A/G are independent risk factors for 30 day survival in ARDS patients. In a prospective study adults (white Germans of Caucasian ethnicity) with ARDS (n=84) were recruited from our intensive care unit, and genotyped for the ACE I/D and the AGT (-6)A/G polymorphism as were 200 healthy white Caucasian controls. Mortality was increased (p=0.015) in the ACE DD genotype compared to the I allele, and the ACE I/D polymorphism was an independent prognostic factor for 30 day survival. Patients with a homozygous DD genotype were at highest risk for death (hazard ratio, HR, 5.7; 95% CI 1.7-19.2; p=0.005) compared to the II genotype. In contrast, the AGT (-6)A/G polymorphism was neither associated with an increased risk for development of ARDS nor with outcome. In patients with ARDS, the ACE I/D polymorphism but not the AGT (-6)A/G promoter polymorphism is an independent risk factor with a pronounced effect on 30 day survival.
Keywords: Angiotensin converting enzyme insertion/deletion polymorphism, ARDS, intrapulmonary renin-angiotensin-system
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