title: Genes and outcome after aneurysmal subarachnoid haemorrhage.
abstract: OBJECTIVE
  Initial and secondary ischaemia are important determinants of outcome after subarachnoid haemorrhage (SAH). Cerebral ischaemia is a potent stimulus for expression of genes that may influence recovery.We investigated whether functional polymorphisms in the apolipoprotein E (APOE), insulin-like growth factor-1 (IGF-1), tumor necrosis factor-A (TNF-A), interleukin-1A (IL-1A), interleukin-1B (IL-1B), and interleukin-6 (IL-6) genes are related with outcome after aneurysmal SAH.
  
  
  METHODS
  Genotyping of the polymorphisms was performed in a consecutive series of 167 patients with aneurysmal SAH. The risk of a poor outcome was analysed with logistic regression with adjustment for prognostic factors for outcome after SAH, using the homozygotes for the wild type alleles as a reference.
  
  
  RESULTS
  Patients carrying any IGF-1 non-wild type allele had a lower risk of a poor outcome (OR 0.4, 95% CI 0.2-1.0), while carriers of the TNF-A non-wild type allele had a higher risk (OR 2.3, 95% CI 1.0-5.4). We could not demonstrate an association with outcome for APOE (APOE epsilon4 OR 0.4, 95% CI 0.1-1.2; APOE epsilon2 OR 0.7, 95% CI 0.2-2.4), IL-1A (OR 1.8, 95% CI 0.8-4.0), IL-1B (OR 0.7, 95% CI 0.3-1.5) and IL-6 (OR 0.7, 95% CI 0.3-1.8) polymorphisms.
  
  
  CONCLUSIONS
  Variation in some genes that are expressed after cerebral ischaemia may partly explain the large differences in outcome between patients with aneurysmal SAH. SAH patients homozygote for the IGF-1 wild type allele or carriers of the TNF-A non-wild type allele have a higher risk of poor outcome. Additional studies in other populations are needed to assess the generalisability of our results.
authors.affiliation: Dept. of Neurology, Rudolf Magnus Institute of Neuroscience University Medical Centre Utrecht, 85500, 3500 GA Utrecht, The Netherlands. ij.m.ruigrok@neuro.azu.nl
authors.forename: Y M
authors.initials: YM
authors.lastname: Ruigrok
authors.forename: A J C
authors.initials: AJ
authors.lastname: Slooter
authors.forename: A
authors.initials: A
authors.lastname: Bardoel
authors.forename: C J M
authors.initials: CJ
authors.lastname: Frijns
authors.forename: G J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: C
authors.initials: C
authors.lastname: Wijmenga
mesh_terms: D000368:Aged; D001057:Apolipoproteins E / Q000235:genetics; D005260:Female; D005786:Gene Expression Regulation / Q000502:physiology*; D005787:Gene Frequency; D005838:Genotype; D023261:Glasgow Outcome Scale; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011110:Polymorphism, Genetic; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000235:genetics*; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics*
chemical_list: D001057:Apolipoproteins E; D014409:Tumor Necrosis Factor-alpha; D007334:Insulin-Like Growth Factor I
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