title: TNFbeta+250 polymorphism and hyperdynamic state in cardiac surgery with extracorporeal circulation.
abstract: We have investigated genetic and clinical factors associated with hyperdynamic state (HS) after heart surgery with extracorporeal circulation (ECC). We performed a prospective cohort study of consecutive patients who underwent elective heart surgery with ECC. HS was defined as hyperthermia (>38 degrees C), cardiac index (CI) >3.5 l/min/m(2) and systemic vascular resistance index (SVRI) <1600 dynes x s/cm(5) x m(2). The study included demographic variables, gene polymorphisms A/G of tumor necrosis factor-beta (TNFbeta+250), G/A-1082 of interleukin-10 (IL-10), polymorphism of interleukin-1 receptor antagonist (IL-1ra), comorbidity, type of surgery, serum levels of interleukin-6 (IL-6), and postoperative course. We used Pearson chi(2) or Fisher exact test, and Student t-test for univariate analysis, with forward stepwise logistic regression for multivariate adjustment. Eighty patients were studied, of whom 22 (27.5%) developed HS. The presence of allele G of TNFbeta+250 polymorphism was associated with an increased incidence of HS (68% vs. 37%; P=0.011). In the multivariate analysis, a longer duration of ECC, and the presence of the G allele, were associated with the development of HS. The G allele of TNFbeta+250 polymorphism, and prolonged extracorporeal circuit times, may favor the development of a hyperdynamic state after heart surgery with ECC.
authors.affiliation: Department of Intensive Care Medicine, Canarias University Hospital, University of La Laguna, La Laguna, Santa Cruz de Tenerife, Spain. joseluis.iribarren@gmail.com
authors.forename: José Luis
authors.initials: JL
authors.lastname: Iribarren
authors.forename: Fernando Martínez
authors.initials: FM
authors.lastname: Sagasti
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Jiménez
authors.forename: Maitane
authors.initials: M
authors.lastname: Brouard
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salido
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Mora
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000235:genetics* / Q000503:physiopathology; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000235:genetics / Q000503:physiopathology; D005787:Gene Frequency; D020022:Genetic Predisposition to Disease; D006439:Hemodynamics / Q000235:genetics*; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000235:genetics; D016753:Interleukin-10 / Q000235:genetics; D016015:Logistic Models; D008233:Lymphotoxin-alpha / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014655:Vascular Resistance / Q000235:genetics
chemical_list: C508609:IL10 protein, human; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D008233:Lymphotoxin-alpha; D016753:Interleukin-10