Vascular endothelial growth factor gene polymorphism and acute respiratory distress syndrome

Background: Non-cardiogenic pulmonary oedema is a characteristic feature of the acute respiratory distress syndrome ( ARDS). The properties of vascular endothelial growth factor ( VEGF) as a potent vascular permogen and mitogen have led to investigation of its potential role in this condition. Lower VEGF plasma levels have been linked to the presence of the T allele in the + 936 CT polymorphism. We hypothesised that the presence of the T allele would be associated with the development and severity of ARDS. Methods: A cohort of 137 normal subjects, 117 ventilated patients with ARDS, and 103 at risk'' of ARDS were genotyped for the VEGF+ 936 CT polymorphism. The severity of physiological disturbance and mortality was determined in the ventilated cohorts. Results: The CT and TT genotype frequencies were increased in ARDS patients compared with both normal subjects ( OR 2.01, 95% CI 1.13 to 3.58, p = 0.02) and those at risk'' ( OR 2.05, 95% CI 1.02 to 2.20, p = 0.03). In patients with ARDS but not those at risk'', CT and TT genotypes were associated with a higher mean APACHE III score ( 80.9 ( 4.3) v 69.3 ( 2.9), p< 0.05). Conclusion: These data support a role for VEGF in the pathogenesis of ARDS and its associated physiological derangement.