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Apolipoprotein E genotype and the association between C‐reactive protein and postoperative delirium: Importance of gene‐protein interactions
Author(s) -
Vasunilashorn Sarinnapha M.,
Ngo Long H.,
Inouye Sharon K.,
Fong Tamara G.,
Jones Richard N.,
Dillon Simon T.,
Libermann Towia A.,
O'Connor Margaret,
Arnold Steven E.,
Xie Zhongcong,
Marcantonio Edward R.
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2019.09.080
Subject(s) - delirium , quartile , incidence (geometry) , c reactive protein , medicine , confidence interval , apolipoprotein e , confusion , relative risk , gastroenterology , inflammation , psychology , intensive care medicine , disease , physics , psychoanalysis , optics
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.