The association between baseline NIH stroke Scale score and APOE polymorphisms in ischemic stroke patients

To investigate the distribution of APOE polymorphisms across ischemic stroke (IS) subtypes classified by the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) and Oxfordshire Community Stroke Project (OCSP) criteria, and to evaluate their association with the baseline National Institute of Health Stroke Scale (NIHSS) score in a Chinese cohort.

A retrospective analysis of 537 IS patients (median age: 67 years, IQR: 61-75) admitted to Shanghai East Hospital (July 2019-June 2021) was conducted. APOE allele/genotype frequencies were analyzed alongside TOAST/OCSP subtypes. Stroke severity was categorized as minor (NIHSS score 0-5) or moderate-severe (NIHSS score > 5). Multivariate logistic regression identified predictors of severity stratified by APOE isoforms.

The APOE-ε3 allele predominated (81.66%), with ε3/ε3 being the most common genotype (67.04%). The ε3 group exhibited higher NIHSS scores (p = 0.041). Independent predictors varied: for ε2, OCSP subtype (OR = 0.316, p = 0.010) and serum nonesterified fatty acids (NEFA, OR = 0.105, p = 0.038); for ε3, OCSP subtype (OR = 0.642, p = 0.014), NEFA (OR = 0.161, p = 0.001), and age (OR = 0.967, p = 0.003). No predictors were identified for ε4.

APOE isoforms differentially influence stroke severity, suggesting personalized management strategies. Ethnicity-specific patterns and study limitations (e.g. single-center design) highlight the need for broader validation.