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Association of APOE ε4 with progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage.
J Neurosurg 2019; :1-8JN

Abstract

OBJECTIVE

The intracranial hematoma volume in patients with traumatic brain injury is a key parameter for the determination of the management approach and outcome. Apolipoprotein E (APOE) ε4 is reported to be a risk factor for larger hematoma volume, which might contribute to a poor outcome. However, whether APOE ε4 is related to progressive hemorrhagic injury (PHI), a common occurrence in the clinical setting, remains unclear. In this study, the authors aimed to investigate the association between the APOE genotype and occurrence of PHI.

METHODS

This prospective study included a cohort of 123 patients with traumatic intracerebral hemorrhage who initially underwent conservative treatment. These patients were assigned to the PHI or non-PHI group according to the follow-up CT scan. A polymerase chain reaction and sequencing method were carried out to determine the APOE genotype. Multivariate logistic regression analysis was applied to identify predictors of PHI.

RESULTS

The overall frequency of the alleles was as follows: E2/2, 0%; E2/3, 14.6%; E3/3, 57.8%; E2/4, 2.4%; E3/4, 22.8%; and E4/4, 2.4%. Thirty-four patients carried at least one allele of ε4. In this study 60 patients (48.8%) experienced PHI, and the distribution of the alleles was as follows: E2/2, 0%; E2/3, 5.7%; E3/3, 22.8%; E2/4, 2.4%; E3/4, 16.3%; and E4/4, 1.6%, which was significantly different from that in the non-PHI group (p = 0.008). Additionally, the late operation rate in the PHI group was significantly higher than that in the non-PHI group (24.4% vs 11.4%, p = 0.002). Multivariate logistic regression identified APOE ε4 (OR 5.14, 95% CI 2.40-11.62), an elevated international normalized ratio (OR 3.57, 95% CI 1.61-8.26), and higher glucose level (≥ 10 mmol/L) (OR 3.88, 95% CI 1.54-10.77) as independent risk factors for PHI. Moreover, APOE ε4 was not a risk factor for the coagulopathy and outcome of the patients with traumatic intracerebral hemorrhage.

CONCLUSIONS

The presence of APOE ε4, an elevated international normalized ratio, and a higher glucose level (≥ 10 mmol/L) are predictors of PHI. Additionally, APOE ε4 is not associated with traumatic coagulopathy and patient outcome.

Authors+Show Affiliations

1Department of Neurosurgery and.1Department of Neurosurgery and.1Department of Neurosurgery and.1Department of Neurosurgery and.1Department of Neurosurgery and.1Department of Neurosurgery and.1Department of Neurosurgery and.1Department of Neurosurgery and.2Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.1Department of Neurosurgery and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31323634

Citation

Wan, Xueyan, et al. "Association of APOE Ε4 With Progressive Hemorrhagic Injury in Patients With Traumatic Intracerebral Hemorrhage." Journal of Neurosurgery, 2019, pp. 1-8.
Wan X, Gan C, You C, et al. Association of APOE ε4 with progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage. J Neurosurg. 2019.
Wan, X., Gan, C., You, C., Fan, T., Zhang, S., Zhang, H., ... Lei, T. (2019). Association of APOE ε4 with progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage. Journal of Neurosurgery, pp. 1-8. doi:10.3171/2019.4.JNS183472.
Wan X, et al. Association of APOE Ε4 With Progressive Hemorrhagic Injury in Patients With Traumatic Intracerebral Hemorrhage. J Neurosurg. 2019 Jul 19;1-8. PubMed PMID: 31323634.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of APOE ε4 with progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage. AU - Wan,Xueyan, AU - Gan,Chao, AU - You,Chao, AU - Fan,Ting, AU - Zhang,Suojun, AU - Zhang,Huaqiu, AU - Wang,Sheng, AU - Shu,Kai, AU - Wang,Xiong, AU - Lei,Ting, Y1 - 2019/07/19/ PY - 2018/12/11/received PY - 2019/04/18/accepted PY - 2019/7/20/entrez PY - 2019/7/20/pubmed PY - 2019/7/20/medline KW - AD = Alzheimer disease KW - APOE = apolipoprotein E KW - APOE genotype KW - APTT = activated partial thromboplastin time KW - CAA = cerebral amyloid angiopathy KW - GCS = Glasgow Coma Scale KW - GOS = Glasgow Outcome Scale KW - INR = international normalized ratio KW - PCR = polymerase chain reaction KW - PHI = progressive hemorrhagic injury KW - PLT = platelet count KW - PT = prothrombin time KW - TBI = traumatic brain injury KW - coagulopathy KW - progressive hemorrhagic injury KW - therapeutic approach KW - traumatic brain injury SP - 1 EP - 8 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVE: The intracranial hematoma volume in patients with traumatic brain injury is a key parameter for the determination of the management approach and outcome. Apolipoprotein E (APOE) ε4 is reported to be a risk factor for larger hematoma volume, which might contribute to a poor outcome. However, whether APOE ε4 is related to progressive hemorrhagic injury (PHI), a common occurrence in the clinical setting, remains unclear. In this study, the authors aimed to investigate the association between the APOE genotype and occurrence of PHI. METHODS: This prospective study included a cohort of 123 patients with traumatic intracerebral hemorrhage who initially underwent conservative treatment. These patients were assigned to the PHI or non-PHI group according to the follow-up CT scan. A polymerase chain reaction and sequencing method were carried out to determine the APOE genotype. Multivariate logistic regression analysis was applied to identify predictors of PHI. RESULTS: The overall frequency of the alleles was as follows: E2/2, 0%; E2/3, 14.6%; E3/3, 57.8%; E2/4, 2.4%; E3/4, 22.8%; and E4/4, 2.4%. Thirty-four patients carried at least one allele of ε4. In this study 60 patients (48.8%) experienced PHI, and the distribution of the alleles was as follows: E2/2, 0%; E2/3, 5.7%; E3/3, 22.8%; E2/4, 2.4%; E3/4, 16.3%; and E4/4, 1.6%, which was significantly different from that in the non-PHI group (p = 0.008). Additionally, the late operation rate in the PHI group was significantly higher than that in the non-PHI group (24.4% vs 11.4%, p = 0.002). Multivariate logistic regression identified APOE ε4 (OR 5.14, 95% CI 2.40-11.62), an elevated international normalized ratio (OR 3.57, 95% CI 1.61-8.26), and higher glucose level (≥ 10 mmol/L) (OR 3.88, 95% CI 1.54-10.77) as independent risk factors for PHI. Moreover, APOE ε4 was not a risk factor for the coagulopathy and outcome of the patients with traumatic intracerebral hemorrhage. CONCLUSIONS: The presence of APOE ε4, an elevated international normalized ratio, and a higher glucose level (≥ 10 mmol/L) are predictors of PHI. Additionally, APOE ε4 is not associated with traumatic coagulopathy and patient outcome. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/31323634/Association_of_APOE_ε4_with_progressive_hemorrhagic_injury_in_patients_with_traumatic_intracerebral_hemorrhage L2 - https://thejns.org/doi/10.3171/2019.4.JNS183472 DB - PRIME DP - Unbound Medicine ER -