Case studyAPOE ε4 positive patients suffering severe traumatic head injury are more prone to undergo decompressive hemicraniectomy

- The apolipoprotein E (apoE) gene has been implicated in various conditions.
- STBI patients with the APOE ε4 allele seems to be more prone to undergo DC.
- It may be important to consider the APOE genotype in patients suffering sTBI.

ObjectIn this paper we tested the hypothesis if patients with severe traumatic brain injury and presence of the apolipoprotein E (APOE) ε4 allele are more prone to undergo the surgical procedure decompressive hemicraniectomy (DC) in order to bring the intracranial pressure (ICP) under control.MethodsIn 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.ResultsPatients with the APOE ε4 allele were significantly overrepresented in the DC group.In the APOE ε4 + DC group, ICPmax and ICPmean during the first 36 h were significantly higher and GOSE was significantly worse at 6 months.ConclusionOur data suggest that patients with the APOE ε4 allele are predisposed for the need of DC more often than patients without the APOE ε4 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.