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Effect of angiotensin-converting enzyme gene I/D polymorphism and its expression on clinical outcome in acute respiratory distress syndrome

Introduction

The role of the D allele of the angiotensin-converting enzyme (ACE) gene I/D polymorphism in the clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) remains controversial. We assessed simultaneously the effect of the ACE I/D polymorphisms as well as the serum and BALF ACE levels on prognosis of ARDS patients.

Methods

We recruited 69 mechanically ventilated ALI/ARDS patients. ACE activity levels in serum and BALF were assessed by chemical methods. Patients were genotyped for ACE I/D polymorphisms. Time-to-event analysis evaluated the variables associated with the 28-day and 90-day mortality.

Results

In the multivariable model, age, lung compliance, serum lactate and serum ACE levels were significantly associated with both 28-day and 90-day mortality. No significant correlation was found between serum and BALF ACE levels (Spearman's ρ = 0.054; P = 0.66). Serum ACE concentrations were significantly higher (P = 0.046) in patients with D/D genotype versus the two other groups combined (I/D and I/I genotypes). A meta-analysis of six studies (including ours) provided evidence that the D allele is significantly associated with increased mortality in ALI/ARDS patients, yielding a per-allele odds ratio of 1.76 (95% CI: 1.19 to 2.59). See Figure 1 and Table 1.

Figure 1
figure1

(abstract P102)

Table 1 Characteristics of the study population (n = 69)

Conclusion

Serum ACE levels appear to be affected by the I/D polymorphism and are correlated with prognosis in patients with ALI/ARDS, indicating that further investigation of the clinical significance of the ACE in ARDS might be of value.

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Correspondence to I Tsangaris.

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Tsangaris, I., Tsantes, A., Kopterides, P. et al. Effect of angiotensin-converting enzyme gene I/D polymorphism and its expression on clinical outcome in acute respiratory distress syndrome. Crit Care 17, P102 (2013). https://doi.org/10.1186/cc12040

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Keywords

  • Lactate
  • Lung Injury
  • Acute Lung Injury
  • Acute Respiratory Distress Syndrome
  • Multivariable Model