Research Paper Volume 15, Issue 1 pp 108—118

Association between Apolipoprotein E genotype and functional outcome in acute ischemic stroke

Xiaoming Rong1, *, , Jingjuan Chen2, *, , Dong Pan1, , YuKai Wang2, , Chengguo Zhang2, &, , Yamei Tang1,3,4, ,

  • 1 Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
  • 2 Department of Neurology, First People’s Hospital of Foshan, Foshan, People’s Republic of China
  • 3 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
  • 4 Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People’s Republic of China
* Co-first author

Received: September 27, 2022       Accepted: December 9, 2022       Published: January 13, 2023
How to Cite

Copyright: © 2023 Rong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


This study aims to determine whether APOE alleles would affect the functional outcome in acute ischemic stroke (AIS) and whether the relationship between inflammation and stroke-related disability varies according to APOE genotypes. We retrospectively collected the demographic and clinical data of AIS patients within one week of symptom-onset through medical records review. The primary outcome was dependence or death, defined as modified Rankin scale (mRS) score of 2–6, which was assessed at 3 months. Among 1929 enrolled patients, the prevalence of APOE ε4 carriers was 17.73% (342/1929). There were 394 AIS patients (394/1929, 20.43%) showed poor function outcome of 90-day mRS (2–6), of whom 147 (147/342, 42.98%) were APOE ε4 carriers and 247 (247/1587, 15.56%) were non-ε4 carriers. There was a significant increased probability of poor functional outcome after AIS among APOE ε4 carriers versus non-ε4 carriers (adjusted-OR 4.62, 95% CI 3.51 to 6.09, P < 0.001). Among ε4 carriers, high neutrophil-to-lymphocyte ratio (NLR) was significantly associated with stroke-related disability (Ptrend = 0.035); however, no significant association was observed among non-ε4 carriers. Our study showed that the APOE ε4 carriers had worse functional outcome after AIS as compared with non-ε4 carriers. APOE genotype may modify the relationship between NLR and 3-month stroke outcome.


AIS: acute ischemic stroke; mRS: modified Rankin scale; NIHSS: National Institutes of Health Stroke Scale; NLR: neutrophil-to-lymphocyte ratio; LDL: low density lipoprotein; TC: total cholesterol; TG: triglyceride; SDLDL: small and low-density lipoprotein cholesterol; HCY: homocysteine; CRP: C-reactive protein; ROC: receiver operator characteristic.