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Apolipoprotein E Genotype and Response of Carbon Monoxide Poisoning to Hyperbaric Oxygen Treatment

¹ Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah; ² Pulmonary and Critical Division, Department of Medicine, LDS Hospital, Salt Lake City, Utah; ³ University of Utah School of Medicine, Salt Lake City, Utah; ⁴ Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, Utah; and ⁵ Department of Cardiology, LDS Hospital, Salt Lake City, Utah

Correspondence and requests for reprints should be addressed to Ramona O. Hopkins, Ph.D., Critical Care Medicine, LDS Hospital, Eighth Avenue and C Street, Salt Lake City, UT 84143. E-mail: ramona.hopkins{at}intermountainmail.org

Rationale: Hyperbaric oxygen (HBO₂) reduced the incidence of cognitive sequelae 6 weeks after carbon monoxide (CO) poisoning compared with normobaric oxygen (NBO₂). The apolipoprotein (APOE) 4 allele predicts unfavorable neurologic outcome after brain injury and stroke.

Objectives: To assess the effects of the 4 allele on 6-week cognitive sequelae after CO poisoning.

Methods: We tested APOE genotypes in 86 of 152 CO-poisoned patients from our randomized trial. Logistic regression was used to control for risk factors while testing for effects with the 4 allele or interactions with 4 and treatment on 6-week and 6- and 12-month cognitive sequelae.

Measurements and Main Results: We enrolled 86 patients: 44 received HBO₂ and 42 NBO₂ therapy. A total of 31 (36%) patients had at least one 4 allele. Six-week cognitive sequelae rates for patients treated with HBO₂ and NBO₂, respectively: 4 allele absent, 11% (3/27) and 43% (12/28); 4 allele present, 35% (6/17) and 29% (4/14). The 4 allele was not associated with 6-week cognitive sequelae, 27% (15/55) without and 32% (10/31) with the 4 allele (P = 0.323). The interaction between the 4 allele and treatment was significantly associated with 6-week cognitive sequelae (P = 0.048). The interaction between the 4 allele and treatment was not associated with 6- and 12-month cognitive sequelae.

Conclusions: HBO₂ therapy reduces cognitive sequelae after CO poisoning in the absence of the 4 allele. Because apolipoprotein genotype is unknown at the time of poisoning, we recommend that patients with acute CO poisoning receive HBO₂.

Key Words: apolipoprotein • carbon monoxide • cognitive • genotype • outcomes

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject There is no information regarding the role of the APOE 4 allele on cognitive outcomes or its affect on hyperbaric oxygen (HBO2) treatment after acute CO poisoning. What This Study Adds to the Field HBO2 therapy reduced cognitive sequelae in the absence of the APOE 4 4 allele.

 

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