Variants at the promoter of the interleukin-6 gene are associated with severity and outcome of pneumococcal community-acquired pneumonia

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• 作者：Ignacio Martín-Loeches (1) (2)
  Jordi Solé-Violán (2)
  Felipe Rodríguez de Castro (3) (4)
  M. Isabel García-Laorden (5)
  Luis Borderías (6)
  José Blanquer (7)
  Olga Rajas (8)
  M. Luisa Briones (9)
  Javier Aspa (8)
  Estefanía Herrera-Ramos (5)
  José Alberto Marcos-Ramos (10)
  Ithaisa Sologuren (5)
  Nereida González-Quevedo (5)
  José María Ferrer-Agüero (2)
  Judith Noda (11) (5)
  Carlos Rodríguez-Gallego (4) (5)
  
• 关键词：Streptococcus pneumoniae ; Community ; acquired pneumonia ; Polymorphisms ; IL ; 6 ; Sepsis
• 刊名：Intensive Care Medicine
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：38
• 期：2
• 页码：256-262
• 全文大小：193KB
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• 作者单位：Ignacio Martín-Loeches (1) (2)
  Jordi Solé-Violán (2)
  Felipe Rodríguez de Castro (3) (4)
  M. Isabel García-Laorden (5)
  Luis Borderías (6)
  José Blanquer (7)
  Olga Rajas (8)
  M. Luisa Briones (9)
  Javier Aspa (8)
  Estefanía Herrera-Ramos (5)
  José Alberto Marcos-Ramos (10)
  Ithaisa Sologuren (5)
  Nereida González-Quevedo (5)
  José María Ferrer-Agüero (2)
  Judith Noda (11) (5)
  Carlos Rodríguez-Gallego (4) (5)
  
  1. Critical Care Centre, Corporació Sanitaria Parc Tauli-University Hospital Sabadell, Sabadell, Spain
  2. Intensive Care Unit, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
  3. Respiratory Disease Service, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
  4. Department of Medical and Surgical Sciences, School of Medicine, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
  5. Department of Immunology, Hospital Universitario de Gran Canaria Dr Negrín, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
  6. Respiratory Disease Service, Hospital San Jorge, Huesca, Spain
  7. Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain
  8. Respiratory Disease Service, Hospital Universitario de la Princesa, Madrid, Spain
  9. Respiratory Disease Service, Hospital Clínico y Universitario de Valencia, Valencia, Spain
  10. Intensive Care Unit, Hospital General José Molina Orosa, Lanzarote, Spain
  11. Research Unit, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
  

文摘

Purpose Conflicting results about the role of genetic variability at IL6, particularly the -174 G/C single nucleotide polymorphism (SNP), in sepsis have been reported. We studied the genetic variability at IL6 in patients with community-acquired pneumonia (CAP) and pneumococcal CAP (P-CAP). Methods This was a multicenter, prospective observational study. IL6 -174 was analyzed in 1,227 white Spanish patients with CAP (306 with P-CAP). IL6 1753 C/G (N?=?750), 2954 G/C (N?=?845), and haplotypes defined by these SNPs were also studied. Results In CAP patients the genotype -174 GG were associated with protection against acute respiratory distress syndrome (ARDS) (p?=?0.008, OR?=?0.4, 95% CI 0.2-.8). No other significant associations were observed. However, in patients with P-CAP multivariate analysis adjusted for age, gender, co-morbidity, hospital of origin, and severity (pneumonia severity index, PSI) showed that the IL6 -174 GG genotype was protective against the development of ARDS (p?=?0.002, OR?=?0.25, 95% CI 0.07-.79), septic shock (p?=?0.006, OR?=?0.46, 95% CI 0.18-.79), and multiple organ dysfunction syndrome (p?=?0.02, OR?=?0.53, 95% CI 0.27-.89). P-CAP patients homozygous for IL6 -174 G also showed a higher survival in a logistic regression analysis adjusted for age, gender, co-morbidity, hospital of origin, and PSI (p?=?0.048, OR?=?0.27, 95% CI 0.07-.98). Conclusions Our results indicate that the IL-6 -174 GG genotype is associated with lower severity and mortality in patients with P-CAP. This effect was higher than that observed in patients with CAP irrespective of the causal pathogen involved. Our results highlight the importance of the causal pathogen in genetic epidemiological studies in sepsis.