title: APOE polymorphism is associated with risk of severe sepsis in surgical patients.
abstract: OBJECTIVE
  To test for an association between apolipoprotein E (APOE) genotypes and the occurrence of severe sepsis in an elective surgical cohort.
  
  
  METHODS
  Prospective, observational, single cohort study.
  
  
  METHODS
  Sixteen-bed surgical intensive care unit (ICU) at a university hospital.
  
  
  METHODS
  Patients were 343 patients with planned admission to the ICU after major elective noncardiac surgery.
  
  
  METHODS
  Blood samples, together with demographic data, baseline clinical data, and Acute Physiology and Chronic Health Evaluation II scores, were collected on admission to the ICU and on each subsequent ICU day. APOE genotyping was conducted using a polymerase chain reaction-based assay. The primary outcome was diagnosis of severe sepsis; secondary outcomes included time on mechanical ventilation, ICU length of stay, and ICU mortality.
  
  
  RESULTS
  Severe sepsis was diagnosed in 34 of 343 patients (9.9%). Carriers of the APOepsilon3 allele (one or two copies) had a lower incidence of severe sepsis than patients with no APOepsilon3 allele (p = .014), with a relative risk of 0.284 (95% confidence interval 0.127-0.635). The protective effect of APOepsilon3 genotype on the incidence of severe sepsis remained significant (p < .01) after adjusting for age, gender, or race in a logistic regression model. Supporting our findings, presence of the APOepsilon3 allele was also associated with fewer days spent in the ICU (p = .007). In contrast, APOE genotypes were not associated with duration of mechanical ventilation or ICU mortality.
  
  
  CONCLUSIONS
  In an elective surgical cohort, presence of the APOepsilon3 allele is associated with decreased incidence of severe sepsis and a shorter ICU length of stay.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Eugene W
authors.initials: EW
authors.lastname: Moretti
authors.forename: Richard W
authors.initials: RW
authors.lastname: Morris
authors.forename: Mihai
authors.initials: M
authors.lastname: Podgoreanu
authors.forename: Debra A
authors.initials: DA
authors.lastname: Schwinn
authors.forename: Mark F
authors.initials: MF
authors.lastname: Newman
authors.forename: Ellen
authors.initials: E
authors.lastname: Bennett
authors.forename: Victor G
authors.initials: VG
authors.lastname: Moulin
authors.forename: Uzo U
authors.initials: UU
authors.lastname: Mba
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Laskowitz
mesh_terms: D018806:APACHE; D001057:Apolipoproteins E / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D011184:Postoperative Period; D011446:Prospective Studies; D018805:Sepsis / Q000145:classification*
chemical_list: D001057:Apolipoproteins E