Association between early serum cholinesterase activity and 30-day mortality in sepsis-3 patients: A retrospective cohort study

Abstract

Low serum cholinesterase (SCHE) activity has been associated with poor prognoses in a variety of conditions, including sepsis. However, such an association has not been well characterized since the Third International Consensus Definitions Task Force modified the definition of sepsis to “life-threatening organ dysfunction due to a dysregulated host response to infection” (known as sepsis-3) in 2016. In the current retrospective cohort study, we examined whether 30-day mortality in sepsis-3 patients is associated with SCHE activity. A total of 166 sepsis-3 patients receiving treatment at an emergency intensive care unit (EICU) were included. The 30-day death rate was 33.1% (55/166). SCHE activity upon EICU admission was lower in nonsurvivors (3.3 vs. 4.5 KU/L in survivors, p = 0.0002). Subjects with low SCHE activity (defined as <4 KU/L) had higher 30-day mortality rates than subjects with normal SCHE activity (45.5%, 40/88 vs. 19.2%, 15/78; p<0.001). A multivariate logistic regression analysis revealed an association between 30-day mortality and lower SCHE activity after adjustments for relevant factors, such as acute multiple organ dysfunction. The odds ratio (OR) for every unit decrease in SCHE activity was 2.11 (95% confidence interval (CI), 1.37–3.27; p = 0.0008). The area under the curve (AUC) of SCHE activity for predicting 30-day mortality was 0.67 (95% CI 0.59–0.74), and the AUC of lactate for predicting 30-day mortality was 0.64 (95% CI 0.57–0.70). Using a combination of SCHE and lactate, the AUC was 0.74 (95% CI 0.69–0.83). These data suggest that lower SCHE activity is an independent risk factor for 30-day mortality in sepsis-3 patients.

The value of sepsis biomarkers and their kinetics in the prognosis of septic shock due to bacterial infections

“…There are hundreds of biomarkers that could be potentially used for diagnosis and prognosis in septic patients [3]. However, few studies have evaluated the discriminative power of PCT, CRP, and SChE activity kinetics as predictors of survival outcome in patients admitted to the ICU with septic shock [2][3][4][5][10][11][12].…”

“…So far, many biomarkers have the potential to play a decisive role by providing adjunctive information to guide clinicians to a rapid diagnosis and to adjust a treatment. There are hundreds of biomarkers that could be potentially used for diagnosis and prognosis in septic patients [3][4][5]. To the best our knowledge, procalcitonin (PCT) and C-reactive protein (CRP) have been the most widely investigated [1,2].…”

“…Moreover, in the intensive care unit (ICU), a serial measurement of sepsis biomarkers has been used as an adjunctive tool and as a guide to discontinue the antimicrobial therapies earlier [6][7][8]. However, to date, a few studies have evaluated the discriminative power of PCT, CRP, and SChE kinetics as predictors of survival outcome in patients admitted to the ICU with septic shock [2,4,5,[8][9][10][11][12]. In this study, we aim to explore the value of PCT, CRP, and serum SChE activity kinetics as useful predictors of mortality in patients with septic shock admitted to the ICU.…”

“…In a recent prospective study, Bahloul et al [2] showed that decreased SChE activity can be used as a reliable diagnostic marker for septic shock. More recently, it has been established that the serum cholinesterase (SChE) activity level can be used as prognostic biomarker in septic shock [4,5,10]. In a prospective observational study [4], Zivkovic et al [4] showed that the SChE enzyme activity was markedly reduced in all septic patients during the observation period, and the measured SChE enzyme activity in non-survivors was notably lower than that of the surviving patients for the duration of 28 days.…”

Drop of Butyrylcholinesterase Activity after Cyclophosphamide Conditioning as a Predictive Marker of Liver Transplant-Related Complications and Its Correlation with Transplant-Related Mortality in Pediatric Hematopoietic Stem Cell Recipients

“…BChE is synthesized in the liver and, for this reason, it is commonly used in the clinical routine as a quick and cheap biomarker for liver function, reflecting hepatic synthetic capacity. Lower BChE activity levels correlate with a more extensive liver injury [13] and are associated with disease severity and mortality in critically ill patients [14,15,16], especially with respect to systemic inflammation and sepsis [17,18].…”