title: A logistic equation to determine the validity of tramadol from related gene polymorphisms and psychological factors.
abstract: OBJECTIVE
  This study was performed to develop an algorithm using polymorphisms of CYP2D6, p-gp, OPRM1, COMT and psychological variables to predict tramadol response in Chinese patients recovering from upper limb fracture internal fixation surgery.
  
  
  METHODS
  A total of 250 Han Chinese patients recovering from fracture in the upper limb were enrolled. CYP2D6*10, p-gp G2677T, p-gp C3435T, OPRM1 A118G and COMT Val158Met were detected by the ligase detection reaction (LDR) method. The algorithm was developed with binary logistic regression in cohort 1 (200 patients) and assessed with Wilcoxon signed-rank test in cohort 2 (50 patients).
  
  
  RESULTS
  According to cohort 1, the predictive equation was calculated with the following logistic regression parameters: Logit (1) = 2.304-4.841 × (anxiety I) - 23.709 × (anxiety II) + 2.823 × (p-gp 3435CT) + 5.737 × (p-gp 3435 TT) - 1.586 × (CYP2D6*10 CT) - 4.542 × (CYP2D6*10 TT). The cutoff point for the prediction was defined as a probability value ≥0.5. The equation's positive predictive value is 90%. When applied to a new sample, the equation's positive predictive value is 86%. The Nagelkerke R² of the model is 0.819, the results of the Hosmer and Leme test show a value of 0.981. The nonparametric correlations between predicted and observed response showed significant correlation (coefficient = 0.879; p < 0.001).
  
  
  CONCLUSIONS
  The algorithm we have developed might predict tramadol response in Chinese upper limb fracture patients.
authors.affiliation: Department of Clinical Pharmacology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhao
authors.forename: Jianguo
authors.initials: J
authors.lastname: Sun
authors.forename: Yifu
authors.initials: Y
authors.lastname: Tao
authors.forename: Shukui
authors.initials: S
authors.lastname: Wang
authors.forename: Chunzhi
authors.initials: C
authors.lastname: Jiang
authors.forename: Yubing
authors.initials: Y
authors.lastname: Zhu
authors.forename: Feng
authors.initials: F
authors.lastname: Yu
authors.forename: Junrong
authors.initials: J
authors.lastname: Zhu
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000235:genetics; D000328:Adult; D000465:Algorithms; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D044466:Asian People / Q000235:genetics; D002394:Catechol O-Methyltransferase / Q000235:genetics*; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D005260:Female; D050723:Fractures, Bone / Q000235:genetics / Q000523:psychology / Q000601:surgery; D005787:Gene Frequency / Q000235:genetics; D005838:Genotype; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000235:genetics* / Q000523:psychology; D010597:Pharmacogenetics / Q000379:methods; D020641:Polymorphism, Single Nucleotide / Q000235:genetics*; D011446:Prospective Studies; D011584:Psychology / Q000379:methods; D017450:Receptors, Opioid, mu / Q000235:genetics*; D014147:Tramadol / Q000627:therapeutic use*; D034941:Upper Extremity / Q000601:surgery
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000701:Analgesics, Opioid; C485764:OPRM1 protein, human; D017450:Receptors, Opioid, mu; D014147:Tramadol; D019389:Cytochrome P-450 CYP2D6; C588010:COMT protein, human; D002394:Catechol O-Methyltransferase