title: APOE ε4 positive patients suffering severe traumatic head injury are more prone to undergo decompressive hemicraniectomy.
abstract: OBJECTIVE
  In 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.
  
  
  METHODS
  In this prospective consecutive study patients with sTBI were enrolled (n=48). Inclusion criteria were arrival to our level one trauma university hospital within 24h after trauma, patient age between 15 and 70years, Glasgow Coma Scale (GCS) score ≤8 at the time of intubation and sedation, an initial cerebral perfusion pressure >10mmHg. Venous blood was sampled for APOE genotype determination. Clinical outcome at 6months after injury was assessed with the Extended Glasgow Outcome Scale (GOSE). All surgical procedures needed for each patient were registered.
  
  
  RESULTS
  Patients with the APOE ε4 allele were significantly overrepresented in the DC group. In the APOE ε4+DC group, ICPmaxand ICPmeanduring the first 36h were significantly higher and GOSE was significantly worse at 6months.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Dept of Pharmacology and Clinical Neuroscience, Section of Neurosurgery, Umeå University, Sweden; Dept of Anesthesia and Intensive Care, Section of Neurosurgery, University Hospital Örebro, Sweden. Electronic address: zandra.olivecrona@regionorebroll.se.
authors.forename: Zandra
authors.initials: Z
authors.lastname: Olivecrona
authors.affiliation: Dept of Pharmacology and Clinical Neuroscience, Section of Neurosurgery, Umeå University, Sweden. Electronic address: lars-owe.koskinen@neuro.umu.se.
authors.forename: Lars-Owe D
authors.initials: LD
authors.lastname: Koskinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D053327:Apolipoprotein E4 / Q000235:genetics*; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology / Q000235:genetics / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000706:statistics & numerical data*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D053327:Apolipoprotein E4
keywords: APOE ε4; Hemicraniectomy; Severe traumatic brain injury