Genetic contribution to PONV risk - 23/05/19

Doi : 10.1016/j.accpm.2019.04.012

Stefanie Klenke ^a,^⁎ , Gudrun J. de Vries ^a, Laura Schiefer ^a, Nina Seyffert ^a, Hagen S. Bachmann ^b, Jürgen Peters ^a, Ulrich H. Frey ^a,^c
^a Klinik für Anästhesiologie and Intensivmedizin, University of Duisburg-Essen and Universitätsklinikum Essen, Hufelandstr. 55, D-45122 Essen, Germany
^b Institut für Pharmakologie and Toxikologie, Witten/Herdecke University, Fakultät für Gesundheit, Stockumer Straße 10, D-58453 Witten, Germany
^c Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany

^⁎Corresponding author at: Klinik für Anästhesiologie and Intensivmedizin, Universitätsklinikum Essen, Hufelandstr. 55, D-45122 Essen, Germany.Klinik für Anästhesiologie and Intensivmedizin, Universitätsklinikum EssenHufelandstr. 55EssenD-45122Germany

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Abstract

Background

Clinical risk factors for postoperative nausea and vomiting (PONV) are usually stratified using the Apfel Score. While a genetic predisposition has recently been demonstrated with the muscarinic acetylcholine receptor (CHRM3) rs2165870 single nucleotide polymorphism (SNP), we investigated whether (1) other SNPs contribute to PONV risk and (2) a genetic risk score might summarise genetic PONV risk.

Methods

We retrospectively analysed data from a study with 472 patients undergoing elective surgery. We investigated the SNPs rs3218315 (IL2RB), rs349358 (KCNB2), rs703363 (intergenic variant), rs1800497 (DRD2), rs1799971 (OPRM1), and rs1176713 (HTR3A). A genetic risk score was established and association with PONV investigated.

Results

Early PONV occurred in 37%. There was a significant association of the KCNB2 rs349358 SNP with nausea (P = 0.021), retching (P = 0.001), and PONV (P = 0.006). The rs349358 genotype distribution was TT in 310 and TC/CC in 155 patients. The KCNB2 SNP was associated with an Odds Ratio (OR) of 1.6 for CT/CC vs. TT (95% CI 1–2.5; P = 0.031) to develop PONV and this was independent from the Apfel Score, and the CHRM3 rs2165870 SNP. A genetic risk score based on the CHRM3 rs2165870 and the KCNB2 rs349358 SNP was created and this genetic score (OR per genetic risk score point: 1.6 (1.3–2.1), P < 0.0001) was independent from the Apfel Score (OR per Apfel score point: 1.6 (1.3–1.9), P < 0.0001) associated with PONV.

Conclusion

The KCNB2 rs349358 SNP is also an independent PONV predictor and a genetic risk score has a similar impact on PONV susceptibility compared to the Apfel Score.

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Keywords : PONV, rs2165870, KCNB2, rs349358, Genetic predisposition, Apfel score