title: Effect of angiotensin converting enzyme gene I/D polymorphism and its expression on clinical outcome in acute respiratory distress syndrome.
abstract: BACKGROUND
  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. Our aim was to assess simultaneously the effect of the ACE I/D polymorphisms as well as the serum and BALF ACE levels on prognosis of patients with ARDS.
  
  
  METHODS
  Sixty-nine mechanically ventilated patients with ALI/ARDS were recruited. ACE activity levels both 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. Finally, we performed a meta-analysis of studies examining the association between ACE I/D polymorphisms and mortality of ALI/ARDS patients.
  
  
  RESULTS
  In the multivariable model, age, lung compliance, serum lactate and serum ACE levels were significantly associated with both 28- and 90-day mortality. No significant correlation was found between serum and BALF ACE levels (Spearman's rho=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). The meta-analysis of 6 studies (including ours) provided evidence that 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, 2.59).
  
  
  CONCLUSIONS
  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.
authors: Laboratory of Haematology and Blood Bank Unit, Attiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. atsantes@yahoo.com
authors: A E
authors: AE
authors: Tsantes
authors: P
authors: P
authors: Kopterides
authors: S
authors: S
authors: Bonovas
authors: P
authors: P
authors: Bagos
authors: G
authors: G
authors: Antonakos
authors: G K
authors: GK
authors: Nikolopoulos
authors: A
authors: A
authors: Gialeraki
authors: V
authors: V
authors: Kapsimali
authors: E
authors: E
authors: Kyriakou
authors: S
authors: S
authors: Kokori
authors: K
authors: K
authors: Dima
authors: A
authors: A
authors: Armaganidis
authors: I
authors: I
authors: Tsangaris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic / Q000235:genetics; D011446:Prospective Studies; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000201:enzymology / Q000235:genetics* / Q000628:therapy; D012129:Respiratory Function Tests; D012307:Risk Factors
chemical_list: D007703:Peptidyl-Dipeptidase A