Observational studyCritical care explorations2026
PPARγ Variant rs10865710 and Mortality in Pediatric Septic Shock Stratified by Corticosteroid Exposure.
Observational study in Critical care explorations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
objectivesTo determine whether genetic variation in peroxisome proliferator-activated receptor gamma (PPARγ) is associated with mortality across corticosteroid exposure strata in pediatric septic shock.
designMulticenter prospective observational study.
settingPICUs at multiple U.S. hospitals. PATIENTS: Children 1 week to 10 years old meeting consensus criteria for septic shock.
interventionsNone. MEASUREMENTS AND MAIN
resultsGenomic DNA was genotyped for two PPARγ single nucleotide variants (SNVs; rs10865710 and rs1801282) using TaqMan assays. Associations with 28-day mortality were evaluated using multivariable logistic regression and Cox proportional hazards models, with analyses stratified by systemic corticosteroid exposure within 72 hours. In a subset with whole-blood RNA sequencing, expression quantitative trait locus (eQTL) analyses assessed genotype effects on candidate transcripts. Among 381 patients, both SNVs were in Hardy-Weinberg equilibrium. Carriage of the rs10865710 mutant allele was associated with higher 28-day mortality (10.2% vs. 3.5%; p = 0.009), whereas rs1801282 showed no association. In stratified analyses, rs10865710 carriage was associated with increased mortality among corticosteroid-treated patients (adjusted odds ratio, 5.85; 95% CI, 1.62-30.44; p = 0.015) but not corticosteroid-naive patients. Similarly, in stratified Cox models, rs10865710 carriage was associated with increased hazard of death among corticosteroid-treated patients (hazard ratio, 5.33; 95% CI, 1.43-19.83; p = 0.013). Genotype was not associated with established mortality risk strata or transcriptomic endotype. In eQTL analyses (n = 81), rs10865710 carriage was not associated with PPARγ expression; however, a trend toward lower glucocorticoid receptor (NR3C1) expression was noted (p = 0.07).
conclusionsThe intronic PPARγ variant rs10865710 is associated with increased mortality in pediatric septic shock, with the association most apparent among corticosteroid-treated patients. Although no cis-eQTL effect on PPARγ expression was detected, exploratory data suggest potential differences in glucocorticoid receptor signaling. Prospective validation and mechanistic studies are warranted.
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