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TNFβ+250 polymorphism and hyperdynamic state in cardiac surgery with extracorporeal circulation

^a Department of Intensive Care Medicine, Canarias University Hospital, University of La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
^b Department of Molecular Biology-Research Unit, Canarias University Hospital, University of La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
^c Department of Cardiac Surgery, Canarias University Hospital, University of La Laguna, La Laguna, Santa Cruz de Tenerife, Spain

Corresponding author. Ofra s/n, La Cuesta, 38320-La Laguna (Santa Cruz de Tenerife), Spain. Tel./fax: +922-679145.

E-mail address: joseluis.iribarren{at}gmail.com (J.L. Iribarren).

We have investigated genetic and clinical factors associated with hyperdynamic state (HS) after heart surgery with extracorporeal circulation (ECC). We performed a prospective cohort study of consecutive patients who underwent elective heart surgery with ECC. HS was defined as hyperthermia (>38 °C), cardiac index (CI) >3.5 l/min/m² and systemic vascular resistance index (SVRI) <1600 dynes·s/cm⁵·m². The study included demographic variables, gene polymorphisms A/G of tumor necrosis factor-beta (TNFβ+250), G/A-1082 of interleukin-10 (IL-10), polymorphism of interleukin-1 receptor antagonist (IL-1ra), comorbidity, type of surgery, serum levels of interleukin-6 (IL-6), and postoperative course. We used Pearson ² or Fisher exact test, and Student t-test for univariate analysis, with forward stepwise logistic regression for multivariate adjustment. Eighty patients were studied, of whom 22 (27.5%) developed HS. The presence of allele G of TNFβ+250 polymorphism was associated with an increased incidence of HS (68% vs. 37%; P=0.011). In the multivariate analysis, a longer duration of ECC, and the presence of the G allele, were associated with the development of HS. The G allele of TNFβ+250 polymorphism, and prolonged extracorporeal circuit times, may favor the development of a hyperdynamic state after heart surgery with ECC.

Key Words: Extracorporeal circulation; Cardiac surgery; Genetic polymorphism