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First published online on October 1, 2007
Chest, doi:10.1378/chest.07-1400
A more recent version of this article appeared on January 1, 2008
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Angiotensin-converting enzyme insertion/deletion polymorphism and risk and outcome of pneumonia

Ewoudt MW van de Garde, PharmD1,2; Henrik Endeman, MD3; Vera HM Deneer, PharmD, PhD1; Douwe H Biesma, MD, PhD3; Fakhredin A Sayed-Tabatabaei, MD, PhD4; Henk JT Ruven, PhD5; Hubert GM Leufkens, PharmD, PhD2 and Jules MM van den Bosch, MD, PhD, FCCP6

1Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands 2Utrecht Institute for Pharmaceutical Sciences, Utrecht University, The Netherlands 3Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands 4Medicines Evaluation Board, The Hague, The Netherlands 5Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, The Netherlands 6Department of Pulmonary Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands

e.m.w.vandegarde{at}uu.nl

Abstract

BackgroundRecent studies have suggested involvement of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism in the susceptibility and severity of community-acquired pneumonia in Asian populations. We have explored the hypothesis that the ACE I/D polymorphism affects the risk and outcome of community-acquired pneumonia in a Dutch white Caucasian population.

MethodsThis is a hospital-based prospective observational study including patients with community-acquired pneumonia admitted between October 2004 and August 2006. All patients were genotyped and pneumonia severity and clinical outcome were compared between patients with the II, ID, and DD genotype of the ACE gene. Pneumonia severity was assessed on day of admission and consecutively on day 2,3,5, and 10 of hospital stay using the Acute Physiology Score (APS). Outcomes evaluated were: duration of hospital stay, ICU admittance, in-hospital and 28-days mortality. To study the association between ACE genotype and risk of pneumonia, the distribution of the ACE I/D polymorphism was compared with healthy control subjects from the same geographical region.

ResultsIn total 200 patients with pneumonia and 200 control subjects were included in the study. The mean age of the patients was 63 years. APS scores were not different between the genotype groups on any of the days and all clinical outcomes (duration of hospital stay, ICU admittance, in-hospital and 28-days mortality) were comparable between the three genotype groups. The ACE I/D genotype distribution was identical for patients and control subjects (p=0.973).

ConclusionsThe ACE I/D polymorphism is not associated with risk and outcome of community-acquired pneumonia in the Dutch white Caucasian population.

Key Words: angiotensin-converting enzyme • genetic polymorphisms • outcome assessment • pneumonia






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