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Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery

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Abstract

Background

A relationship between patients with a genetic predisposition to and those who develop postoperative delirium has not been yet determined. The aim of this study was to determine whether there is an association between apolipoprotein E epsilon 4 allele (APOE4) and delirium after major surgery.

Methods

Of 230 intensive care patients admitted to the post anesthesia care unit (PACU) over a period of 3 months, 173 were enrolled in the study. Patients’ demographics and intra- and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist, and DNA was obtained at PACU admission to determine apolipoprotein E genotype.

Results

Fifteen percent of patients developed delirium after surgery. Twenty-four patients had one copy of APOE4. The presence of APOE4 was not associated with an increased risk of early postoperative delirium (4% vs. 17%; P = 0.088). The presence of APOE4 was not associated with differences in any studied variables. Multivariate analysis identified age [odds ratio (OR) 9.3, 95% confidence interval (CI) 2.0–43.0, P = 0.004 for age ≥65 years), congestive heart disease (OR 6.2, 95% CI 2.0–19.3, P = 0.002), and emergency surgery (OR 59.7, 95% CI 6.7–530.5, P < 0.001) as independent predictors for development of delirium. The Simplified Acute Physiology Score II (SAPS II) and The Acute Physiology and Chronic Health Evaluation II (APACHE II) were significantly higher in patients with delirium (P < 0.001 and 0.008, respectively). Hospital mortality rates of these patients was higher and they had a longer median PACU stay.

Conclusions

Apolipoprotein e4 carrier status was not associated with an increased risk for early postoperative delirium. Age, congestive heart failure, and emergency surgery were independent risk factors for the development of delirium after major surgery.

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Acknowledgments

This study was supported by a special grant from the Comissão de Fomento da Investigação em Cuidados de Saúde.

Conflict of interest

The authors did not use funds for the research and have no conflicts of interest.

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Authors and Affiliations

  1. Anesthesiology and Perioperative Care Unit, Surgical Department, Faculty of Medicine, University of Porto, Porto, Portugal

    Fernando José Abelha

  2. Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal

    Fernando José Abelha, Vera Fernandes, Miguela Botelho, Patricia Santos & Alice Santos

  3. Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal

    J. C. Machado

  4. Department of Hygiene and Epidemiology, Faculty of Medicine, University of Porto, Porto, Portugal

    Henrique Barros

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  1. Fernando José Abelha
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Correspondence to Fernando José Abelha.

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Abelha, F.J., Fernandes, V., Botelho, M. et al. Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery. J Anesth 26, 412–421 (2012). https://doi.org/10.1007/s00540-012-1326-5

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  • DOI: https://doi.org/10.1007/s00540-012-1326-5

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