APOE epsilon 4 positive patients suffering severe traumatic head injury are more prone to undergo decompressive hemicraniectomy

作者：Olivecrona Zandra^*; Koskinen Lars Owe D

来源：Journal of Clinical Neuroscience, 2017, 42: 139-142.

DOI：10.1016/j.jocn.2017.03.024

• Severe traumatic brain injury
• APOE epsilon 4
• Hemicraniectomy

Object: In this paper we tested the hypothesis if patients with severe traumatic brain injury and presence of the apolipoprotein E (APOE) epsilon 4 allele are more prone to undergo the surgical procedure decompressive hemicraniectomy (DC) in order to bring the intracranial pressure (ICP) under control.
Methods: In this prospective consecutive study patients with sTBI were enrolled (n = 48). Inclusion criteria were arrival to our level one trauma university hospital within 24 h after trauma, patient age between 15 and 70 years, Glasgow Coma Scale (GCS) score <= 8 at the time of intubation and sedation, an initial cerebral perfusion pressure >10 mm Hg. Venous blood was sampled for APOE genotype determination. Clinical outcome at 6 months after injury was assessed with the Extended Glasgow Outcome Scale (GOSE). All surgical procedures needed for each patient were registered.
Results: Patients with the APOE epsilon 4 allele were significantly overrepresented in the DC group. In the APOE epsilon 4 + DC group, ICPmax and ICPmean mean during the first 36 h were significantly higher and GOSE was significantly worse at 6 months.
Conclusion: Our data suggest that patients with the APOE epsilon 4 allele are predisposed for the need of DC more often than patients without the APOE epsilon 4 allele. Thus, it seems to be of importance to consider the APOE genotype in patients suffering severe traumatic brain injury in order to forecast the need for a more exquisite intensive care.

• 出版日期2017-8