Sarinnapha M Vasunilashorn1,2,3, Long H Ngo1,2,4, Sharon K Inouye1,2,5, Tamara G Fong2,5,6, Richard N Jones5,7, Simon T Dillon1,2, Towia A Libermann1,2, Margaret O'Connor2,8, Steven E Arnold2,9, Zhongcong Xie2,10, Edward R Marcantonio1,2,5. 1. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 2. Harvard Medical School, Boston, MA, USA. 3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 4. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 5. Marcus Institute for Aging Research, Boston, MA, USA. 6. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 7. Brown University Warren Alpert Medical School, Providence, RI, USA. 8. Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. 9. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. 10. Department of Anesthesiology, Massachusetts General Hospital, Boston, MA, USA.
Abstract
INTRODUCTION: 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.
INTRODUCTION: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.
Authors: Sharon K Inouye; Edward R Marcantonio; Cyrus M Kosar; Douglas Tommet; Eva M Schmitt; Thomas G Travison; Jane S Saczynski; Long H Ngo; David C Alsop; Richard N Jones Journal: Alzheimers Dement Date: 2016-04-18 Impact factor: 21.566
Authors: Sarinnapha M Vasunilashorn; Long H Ngo; Richard N Jones; Sharon K Inouye; Kathryn T Hall; Jacqueline Gallagher; Simon T Dillon; Zhongcong Xie; Towia A Libermann; Edward R Marcantonio Journal: Am J Geriatr Psychiatry Date: 2018-09-14 Impact factor: 4.105
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Authors: Barbara C van Munster; Johanna C Korevaar; Aeilko H Zwinderman; Mariska M Leeflang; Sophia E J A de Rooij Journal: Am J Geriatr Psychiatry Date: 2009-10 Impact factor: 4.105
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Authors: Tamara G Fong; Sarinnapha M Vasunilashorn; Edward R Marcantonio; Sharon K Inouye; Long Ngo; Towia A Libermann; Simon T Dillon; Eva M Schmitt; Alvaro Pascual-Leone; Steven E Arnold; Richard N Jones Journal: Ann Neurol Date: 2020-09-15 Impact factor: 10.422