TNFbeta+250 polymorphism and hyperdynamic state in cardiac surgery with extracorporeal circulation.
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.
Iribarren
José Luis
JL
Department of Intensive Care Medicine, Canarias University Hospital, University of La Laguna, La Laguna, Santa Cruz de Tenerife, Spain. joseluis.iribarren@gmail.com
Sagasti
Fernando Martínez
FM
Jiménez
Juan José
JJ
Brouard
Maitane
M
Salido
Eduardo
E
Martínez
Rafael
R
Mora
María Luisa
ML
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
C508609:IL10 protein, human; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D008233:Lymphotoxin-alpha; D016753:Interleukin-10