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Apolipoprotein E polymorphism and outcome after closed traumatic brain injury: influence of ethnic and regional differences

Narendra Nathoo Departments of Neurosurgery, Pathology, and Molecular Biology, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal; Medical Research Council of South Africa (Division of Biostatistics), Durban, South Africa; and West London Neurosciences Center and Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom

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 M.D., F.C.S.
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Runjan Chetty Departments of Neurosurgery, Pathology, and Molecular Biology, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal; Medical Research Council of South Africa (Division of Biostatistics), Durban, South Africa; and West London Neurosciences Center and Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom

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 M.D., F.R.C.Path., Ph.D.
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James R. van Dellen Departments of Neurosurgery, Pathology, and Molecular Biology, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal; Medical Research Council of South Africa (Division of Biostatistics), Durban, South Africa; and West London Neurosciences Center and Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom

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 M.D., F.R.C.S., Ph.D.
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Catherine Connolly Departments of Neurosurgery, Pathology, and Molecular Biology, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal; Medical Research Council of South Africa (Division of Biostatistics), Durban, South Africa; and West London Neurosciences Center and Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom

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 M.P.H. (Biostatistics)
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Richard Naidoo Departments of Neurosurgery, Pathology, and Molecular Biology, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal; Medical Research Council of South Africa (Division of Biostatistics), Durban, South Africa; and West London Neurosciences Center and Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom

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 Ph.D.
Page Range:
302–306
Volume/Issue:
Volume 98: Issue 2
DOI link:
https://doi.org/10.3171/jns.2003.98.2.0302
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Object. The presence of the apolipoprotein E-ϵ4 (APOE-ϵ4) allele is reported to be associated with poor outcome after traumatic brain injury (TBI). This study was performed to determine if the presence of the APOE-ϵ4 allele influenced outcome in a cohort of black patients with TBI who had homogeneous neuropathological findings.

Methods. Venous blood was collected at the time of admission to determine the APOE genotype in black Zulu-speaking patients who presented with traumatic cerebral contusions. The frequency of the APOE-ϵ4 allele's appearance was correlated with outcome at a minimum of 6 months of follow up. Univariate and multivariate analyses were performed to determine independent risk factors and to control for confounding factors.

In 110 black Zulu-speaking patients with traumatic cerebral contusions, genotypes for APOE were analyzed. Eleven of 45 (24.4%) with the APOE-ϵ4 allele experienced a poor outcome, compared with 10 (15.4%) of 65 without this allele (p = 0.34). Both patients with homozygous APOE-ϵ4 alleles experienced a good outcome (Glasgow Outcome Score 5). Univariate and multivariate analysis revealed no significant relationship in patients with the APOE-ϵ4 allele with regard to age, admission Glasgow Comas Scale score, contusion volume, type of neurosurgical management, and outcome. The risk of a poor outcome was, however, greater in patients with the APOE-ϵ4 allele (relative risk 1.59; 95% confidence interval 0.74–3.42).

Conclusions. The authors recorded no relationship between APOE-ϵ4 allele status and outcome after TBI in black patients. Given the high regional susceptibility to the APOE gene, further studies, possibly even community-based investigations and studies conducted in other geographic areas, are probably warranted.

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Contributor Notes

Address reprint requests to: Narendra Nathoo, M.D., F.C.S., Department of Neurosurgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195. email: nathoon@ccf.org.
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