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The Rate of Pyrin Mutations in Critically Ill Patients with Systemic Inflammatory Response Syndrome and Sepsis: A Pilot Study

BAYRAM KOC, CAGATAY OKTENLI, FATIH BULUCU, NURI KARADURMUS, S. YAVUZ SANISOGLU, and DAVUT GUL

ABSTRACT.

Objective. The role of individual genetic differences in susceptibility to systemic inflammatory response syndrome (SIRS) and sepsis is generally unrecognized or underestimated. We investigated the rate of pyrin mutations in critically ill patients with SIRS and sepsis, and compared whether carriers for pyrin mutations are associated with respect to the frequency of and certain features of sepsis and SIRS.

Methods. We tested M694V, M680I, V726A, R761H, and M694I mutations in critically ill patients.

Results. Twenty-four of 80 (30%) critically ill patients were found to carry some pyrin mutations; none had a history compatible with familial Mediterranean fever. We also found a high frequency of carriers in patients having pneumonia (30.3%), urinary tract infection (29.4%), and acute pancreatitis (30.8%). When we compared our results with the pyrin mutation carrier rate of a healthy Turkish population (10%), the rate of pyrin mutations in all patients (p < 0.001), and patients with urinary tract infection (p < 0.001), acute pancreatitis (p < 0.001), and pneumonia (p < 0.001) were found to be significantly high. The white blood cell count, erythrocyte sedimentation rate, lactic dehydrogenase, and rate of fever and pulse were significantly higher, whereas systolic and diastolic blood pressure and albumin levels were significantly lower in patients with pyrin mutation compared to those without the mutation.

Conclusion. Our results showed that critically ill patients with SIRS and sepsis have increased prevalence of pyrin mutations, and patients with SIRS and sepsis carrying the pyrin mutation seem to be highly susceptible for a severe disease course. (First Release August 1 2007; J Rheumatol 2007;34:2070-4)

Key Indexing Terms:

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
SEPSIS
PYRIN MUTATION
CRITICAL ILLNESS

From the Department of Internal Medicine and Department of Medical Genetics, Gülhane Military Medical Academy, Ankara; Division of Internal Medicine, GATA Haydarpasa Training Hospital, Istanbul; and Department of Monitoring and Evaluation, Turkish Ministry of Health, Ankara, Turkey.

B. Koc, MD; F. Bulucu, MD; N. Karadurmus, MD, Department of Internal Medicine, Gülhane Military Medical Academy; C. Oktenli, MD, Division of Internal Medicine, GATA Haydarpasa Training Hospital; S.Y. Sanisoglu, PhD, Department of Monitoring and Evaluation, Turkish Ministry of Health; D. Gul, MD, Department of Medical Genetics, Gülhane Military Medical Academy.

Address reprint requests to Dr. B. Koc, Department of Internal Medicine, Gülhane Military Medical Academy, TR-06018 Etlik, Ankara, Turkey. E-mail: bkoc@gata.edu.tr

Accepted for publication June 13, 2007.