Association between surfactant protein B + 1580 polymorphism and the risk of respiratory failure in adults with community-acquired pneumonia.

Abstract

OBJECTIVE:

Pulmonary surfactant protein (SP)-B plays a vital role in the formation and function of surfactant in the lung. A genetic polymorphism (SP-B + 1580) is postulated to result in diminished activity of SP-B. The objective was to determine whether the SP-B + 1580 CC genotype is associated with an increased risk of respiratory failure and ARDS in adults with community-acquired pneumonia.

DESIGN:

Prospective cohort of adults diagnosed with community-acquired pneumonia.

SETTING:

Hospital system.

PATIENTS:

We enrolled 402 adults > or = 18 yrs of age with community-acquired pneumonia; 158 were white, 243 were African American, and one was Asian.

INTERVENTIONS:

Genotypic analysis was performed on DNA isolated from whole blood using polymerase chain reaction amplification and DdeI restriction enzyme digestion.

MEASUREMENTS AND MAIN RESULTS:

We recorded the requirement for mechanical ventilation, the presence of acute respiratory distress syndrome (ARDS) or septic shock, and mortality. Sixty-three patients required mechanical ventilation, 12 patients developed ARDS, and 35 patients developed septic shock. Genotypic frequencies at the SP-B + 1580 site were T/T 183 of 402 (0.45), T/C 160 of 402 (0.40), and C/C 59 of 402 (0.15). Of the 59 patients who were C/C at the SP-B + 1580 site, 21 (0.356) required mechanical ventilation, compared with 26 of 160 patients (0.163) who were T/C and 16 of 183 (0.087) patients who were T/T (p < .001). ARDS developed in five of 59 (0.085) patients with the C/C genotype, compared with six of 160 (.038) patients with T/C and one of 183 patients with T/T (0.005, p < .009). Septic shock occurred in 12 of 59 (0.203) patients with the C/C genotype, compared with 13 of 160 (0.081) patients with T/C and ten of 183 (0.055) patients with T/T (p < .001). Mortality rate was not different between the three genotypes.

CONCLUSION:

Carriage of the C allele at the SP-B + 1580 site is associated with ARDS, septic shock, and the need for mechanical ventilation in adults with community-acquired pneumonia.

• Authors: Michael W Quasney, Grant W Waterer, Mary K Dahmer, Grace K Kron, Qing Zhang, Lori A Kessler, Richard G Wunderink
• Journal: Critical care medicine (Crit Care Med) Vol. 32 Issue 5 Pg. 1115-9 (May 2004) ISSN: 0090-3493 [Print] United States
• PMID: 15190959 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Pulmonary Surfactant-Associated Protein B

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Case-Control Studies
• Cause of Death
• Chromosomes, Human, Pair 2 (genetics)
• Community-Acquired Infections (complications)
• Female
• Gene Frequency
• Genetic Predisposition to Disease (genetics)
• Genotype
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Pneumonia (complications)
• Polymerase Chain Reaction
• Polymorphism, Genetic (genetics)
• Prospective Studies
• Pulmonary Surfactant-Associated Protein B (genetics, physiology)
• Respiration, Artificial (statistics & numerical data)
• Respiratory Distress Syndrome (etiology, mortality, therapy)
• Respiratory Insufficiency (etiology, mortality, therapy)
• Restriction Mapping
• Risk Factors
• Shock, Septic (etiology, mortality, therapy)
• Tennessee (epidemiology)