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Genotype Linked to Cardiac Surgery Outcomes

Last Updated: May 05, 2009.

 

Those with low-activity allele had higher plasma catecholamine, more acute kidney injury

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Patients who were homozygous for the low activity catechol-O-methyltransferase L allele had a higher risk of vasodilatory shock and acute kidney injury following cardiac surgery with cardiopulmonary bypass, according to research published online April 30 in the Journal of the American Society of Nephrology.

TUESDAY, May 5 (HealthDay News) -- Patients who were homozygous for the low activity catechol-O-methyltransferase (COMT) L allele had a higher risk of vasodilatory shock and acute kidney injury following cardiac surgery with cardiopulmonary bypass, according to research published online April 30 in the Journal of the American Society of Nephrology.

Anja Haase-Fielitz, of Austin Health in Melbourne, Australia, and colleagues analyzed data from 260 white patients undergoing elective cardiac surgery with cardiopulmonary bypass. Genetic analysis revealed that 24.6 percent were COMT homozygous for low activity (LL), 47.3 percent were heterozygous (HL), and 28.1 percent were homozygous for high activity (HH).

The researchers discovered that vasodilatory shock occurred in 69, 57, and 47 percent of LL, HL, and HH patients, respectively, and lasted for a longer median duration in LL patients than in HH patients (18.5 versus 11 hours). Acute kidney injury occurred more often in LL patients than in HH patients (31 versus 13.7 percent), and their injury was more severe.

"Our findings provide a conceptual framework for further studies in vasodilatory shock and acute kidney injury in sepsis. Perhaps more suitable hemodynamics could be achieved in LL patients were they given vasopressin rather than catecholamines, and acute kidney injury might be attenuated by avoidance of cardiopulmonary bypass and nephrotoxic medications. If confirmed in larger trials, preoperative COMT genotyping together with known clinical risk factors could aid in preoperative risk stratification to anticipate occurrence of circulatory and renal dysfunction, and prolonged recovery," the authors conclude.

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