Apolipoprotein E genotype and the association between C-reactive protein and postoperative delirium: Importance of gene-protein interactions.

Abstract

INTRODUCTION:

Apolipoprotein E (APOE) status may modify the risk of postoperative delirium conferred by inflammation.

METHODS:

We tested whether APOE modifies the established association between C-reactive protein (CRP) and delirium incidence, severity, and duration in 553 noncardiac surgical patients aged 70 and older. High postoperative plasma CRP (≥234.12 mg/L) was defined by the highest sample-based quartile. Delirium was determined using the Confusion Assessment Method and chart review, and severity was determined by the Confusion Assessment Method-Severity score.

RESULTS:

APOE ε4 carrier prevalence was 19%, and postoperative delirium occurred in 24%. The relationship between CRP and delirium incidence, severity, and duration differed by ε4 status. Among ε4 carriers, there was a strong relationship between high CRP (vs. low CRP) and delirium incidence (relative risk [95% confidence interval], 3.0 [1.4-6.7]); however, no significant association was observed among non-ε4 carriers (relative risk [95% CI], 1.2 [0.8-1.7]).

DISCUSSION:

Our findings raise the possibility that APOE ε4 carrier status may modify the relationship between postoperative day 2 CRP levels and postoperative delirium.

• Authors: Sarinnapha M Vasunilashorn, Long H Ngo, Sharon K Inouye, Tamara G Fong, Richard N Jones, Simon T Dillon, Towia A Libermann, Margaret O'Connor, Steven E Arnold, Zhongcong Xie, Edward R Marcantonio
• Journal: Alzheimer's & dementia : the journal of the Alzheimer's Association (Alzheimers Dement) Vol. 16 Issue 3 Pg. 572-580 (03 2020) ISSN: 1552-5279 [Electronic] United States
• PMID: 31761478 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 the Alzheimer's Association.

Chemical References

• Apolipoprotein E4
• Apolipoproteins E
• C-Reactive Protein

Topics

• Aged
• Aged, 80 and over
• Alleles
• Apolipoprotein E4
• Apolipoproteins E (genetics)
• C-Reactive Protein (analysis)
• Delirium (epidemiology, etiology)
• Epistasis, Genetic
• Female
• Genotype
• Humans
• Postoperative Complications