title: Association between heat shock protein 70 gene polymorphisms and clinical outcomes in intensive care unit patients with sepsis.
abstract: OBJECTIVE
  The objective of the following study is to evaluate the associations between single nucleotide polymorphisms (SNPs) in the Heat Shock Protein 70 (HSP70) gene, gene expression of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) and medical intensive care unit (MICU) stay and organ failure in sepsis.
  
  
  METHODS
  MICU patients with sepsis were genotyped for rs1061581, rs2227956, rs1008438 and rs1043618 polymorphisms in HSP70 gene using polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis or allele-specific PCR. Messenger ribonucleic acid (mRNA) expression of IL-6 and TNF-α were quantitated in peripheral blood lymphocytes. Outcomes were recorded.
  
  
  RESULTS
  108 patients (48 male) aged 40.7 ± 16.0 (mean ± standard deviation) years included H1N1 infection (36), scrub typhus (29) and urosepsis (12). Seventy-one (65.7%) had dysfunction of three or more organ systems, 66 patients (61.1%) were treated by mechanical ventilation, 21 (19.4%) needed dialysis. ICU stay was 9.3 ± 7.3 days. Mortality was 38.9%. One or more SNPs were noted in 101/108 (93.5%) and organ failure was noted in only 1/7 patients without a single SNP. The A allelotypes of rs1061581 and rs1008438 were associated with hematological dysfunction (P = 0.03 and 0.07) and longer ICU stay (P = 0.05 and 0.04), whereas IL-6 and TNF-α mRNA levels were associated with central nervous system dysfunction.
  
  
  CONCLUSIONS
  HSP70 genotypes may determine some adverse outcomes in patients with sepsis.
authors.affiliation: Department of Intensive Care, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India ; Department of Internal Medicine, Unity Health System, Rochester, NY 14626, USA ; Department of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Kartik
authors.initials: K
authors.lastname: Ramakrishna
authors.affiliation: Department of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Pugazhendhi
authors.affiliation: Department of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Jayakanthan
authors.initials: J
authors.lastname: Kabeerdoss
authors.affiliation: Department of Intensive Care, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: John Victor
authors.initials: JV
authors.lastname: Peter
keywords: Inflammatory response; innate immunity; interleukin-6; tumor necrosis factor-alpha