Bedside-measurement of serum cholinesterase activity predicts patient morbidity and length of the intensive care unit stay following major traumatic injury

Abstract

Major traumatic injury (MTI), a life-threatening condition requiring prompt medical intervention, is associated with an extensive inflammatory response often resulting in multiple organ dysfunction. Early stratification of trauma severity and the corresponding inflammation may help optimize resources at the intensive care unit (ICU). The cholinergic system counters inflammation by quickly modulating the immune response. Serum cholinesterase (butyrylcholinesterase, BChE) is an enzyme that hydrolyses acetylcholine. We tested whether a change in the BChE activity correlates with the morbidity and the length of ICU stay. Blood samples from 10 healthy volunteers and 44 patients with MTI were gathered at hospital admission, followed by measurements 12, 24 and 48 hours later. Point-of-care approach was used to determine the BChE activity. Disease severity was assessed by clinical scoring performed within 24 hours following hospital admission. BChE activity, measured at hospital admission, showed a significant and sustained reduction and correlated with disease severity scores obtained 24 hours following admission. BChE activity, obtained at hospital admission, correlated with the length of ICU stay. Bedside measurement of BChE activity, as a complementary addition to established procedures, might prove useful in the primary assessment of the disease severity and might therefore optimize therapy in the ICU.

Butyrylcholinesterase as a perioperative complication marker in patients after transcatheter aortic valve implantation: a prospective observational study

“…Zivkovic et al 10 showed that bedsidemeasurement of BChE activity predicts patient morbidity and length of ICU stay following major traumatic injury. 21 Another study with patients undergoing venoarterial extracorporeal membrane oxygenation therapy after Open access cardiac surgery revealed BChE as a strong predictor of all-cause and cardiovascular mortality.…”

Different Pharmacokinetics of Tramadol, O-Demethyltramadol and N-Demethyltramadol in Postoperative Surgical Patients From Those Observed in Medical Patients

“…LChE: cholinesterase ≤4244 U L −1 ; NChE, cholinesterase >4244 U L −1 ; NRS, Numeric Rating Scale; *statistically significant differences in NRS between LChE and NChE group (upper cluster-Mann-Whitney U test) and in NRS before and after tramadol within the same group (lower cluster-Wilcoxon test). et al have observed that the plasma activity of ChE after traumainduced systemic inflammation decreases before standard proinflammatory biomarkers began to increase, and confirmed its importance in the early diagnosis of systemic inflammation, and in predicting morbidity and mortality (Zivkovic et al, 2016;Zivkovic et al, 2019). Li et al demonstrated that low ChE activity at the time of hospitalization was an independent risk factor for death in patients with ischemic stroke.…”

Cholinesterase level is a predictor of systemic inflammatory response syndrome and complications after cardiopulmonary bypass

“…Cholinergic parameters are associated with a variety of inflammatory markers, including fibrinogen, IL-6, and CRP (18). The measurement of the S-ChE activity can be used to quickly assess the nonneuronal cholinergic activity upon an inflammatory response (19). de Oliveira et al (20) showed that there is a cell-specific mechanism for regulating the expression of AChE in inflammation.…”