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Glucocorticoid Receptor Polymorphisms and Outcomes in Pediatric Septic Shock
Natalie Z Cvijanovich1, Nick Anas, Geoffrey L Allen
11Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA. 2Department of Pediatrics, Children's Hospital of Orange County, Orange, CA. 3Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO. 4Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA. 5Department of Pediatrics, Akron Children's Hospital, Akron, OH. 6Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 7Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX. 8Department of Pediatrics, Miami Children's Hospital, Miami, FL. 9Department of Pediatrics, C.S. Mott Children's Hospital at the University of Michigan, Ann Arbor, MI. 10Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI. 11Department of Pediatrics, Children's National Health System, Washington, DC. 12Department of Pediatrics, Children's Hospital and Clinics of Minnesota, Minneapolis, MN. 13Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN. 14Department of Pediatrics, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, NJ. 15Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, GA. 16Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH. 17Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Glucocorticoid receptor gene polymorphisms did not show a benefit of corticosteroids in children with septic shock. However, wild-type allele homozygotes had worse outcomes with corticosteroid use.
Area of Science:
- Genetics
- Pediatrics
- Critical Care Medicine
Background:
- Glucocorticoid receptor gene polymorphisms influence outcomes and corticosteroid response in inflammatory conditions.
- Septic shock in children is a critical illness with significant morbidity and mortality.
Purpose of the Study:
- To investigate the association between glucocorticoid receptor gene polymorphisms and outcomes in children with septic shock.
- To determine if these polymorphisms affect corticosteroid responsiveness in pediatric septic shock.
Main Methods:
- A candidate gene association study genotyped 482 children with septic shock for specific glucocorticoid receptor polymorphisms.
- Outcome was defined as 28-day mortality or persistent organ failure at 7 days.
- Logistic regression analyzed the association between corticosteroid exposure and outcome, adjusted for illness severity.
Main Results:
- No significant differences in outcome were observed across different genotype groups.
- In children homozygous for the wild-type glucocorticoid receptor allele, corticosteroid use was linked to a higher likelihood of a complicated course (OR, 2.30; 95% CI, 1.01-5.21).
Conclusions:
- The studied glucocorticoid receptor polymorphisms did not identify a subgroup of children with septic shock who benefit from corticosteroids.
- Corticosteroid administration was associated with increased odds of poor outcomes in children homozygous for the wild-type glucocorticoid receptor allele.
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