Polymorphism in the surfactant protein-B gene, gender, and the risk of direct pulmonary injury and ARDS.
OBJECTIVE
Major risk factors for ARDS have been identified. However, only a minority of patients with such risks develops ARDS. It is likely that, given the same type and degree of insult, there are heritable determinants of susceptibility to ARDS. To investigate the possibility of variable genetic susceptibility to ARDS, we examined the association between ARDS and a polymorphism in intron 4 of the surfactant protein-B (SP-B) gene.


METHODS
Nested case-control study conducted from September 1999 to March 2001.


METHODS
Four adult medical and surgical ICUs at a tertiary academic center.


METHODS
One hundred eighty-nine patients meeting study criteria for a defined risk factor for ARDS were enrolled and prospectively followed.


RESULTS
Seventy-two patients (38%) developed ARDS. After stratification by gender and adjustment for potential confounders, there was a significantly increased odds for women with the variant SP-B gene to develop ARDS compared to women homozygous for the wild-type allele (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.1 to 18.8; p = 0.03). Women with the variant SP-B polymorphism also had significantly increased odds of having a direct pulmonary injury such as aspiration or pneumonia as a risk factor for ARDS as opposed to an indirect pulmonary risk for ARDS (OR, 4.6; 95% CI, 1.1 to 19.9; p = 0.04). No such association with ARDS or direct pulmonary injury was found for men.


CONCLUSIONS
The variant polymorphism of the SP-B gene is associated with ARDS and with direct pulmonary injury in women, but not in men. Further study is needed to confirm the association between the variant SP-B gene, and gender, ARDS, and direct pulmonary injury.
Gong
Michelle Ng
MN
Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Goston, MA 02115, USA.
Wei
Zhou
Z
Xu
Li-Lian
LL
Miller
David P
DP
Thompson
B Taylor
BT
Christiani
David C
DC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005787:Gene Frequency; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000235:genetics*; D012307:Risk Factors; D012737:Sex Factors