Reduced Serum Butyrylcholinesterase Activity Indicates Severe Systemic Inflammation in Critically Ill Patients

Abstract

Systemic inflammation is an immune response to a nonspecific insult of either infectious or noninfectious origin and remains a challenge in the intensive care units with high mortality rate. Cholinergic neurotransmission plays an important role in the regulation of the immune response during inflammation. We hypothesized that the activity of butyrylcholinesterase (BChE) might serve as a marker to identify and prognose systemic inflammation. By using a point-of-care-testing (POCT) approach we measured BChE activity in patients with severe systemic inflammation and healthy volunteers. We observed a decreased BChE activity in patients with systemic inflammation, as compared to that of healthy individuals. Furthermore, BChE activity showed an inverse correlation with the severity of the disease. Although hepatic function has previously been found essential for BChE production, we show here that the reduced BChE activity associated with systemic inflammation occurs independently of and is thus not caused by any deficit in liver function in these patients. A POCT approach, used to assess butyrylcholinesterase activity, might further improve the therapy of the critically ill patients by minimizing time delays between the clinical assessment and treatment of the inflammatory process. Hence, assessing butyrylcholinesterase activity might help in early detection of inflammation.

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

“…Reduced serum albumin concentration correlates with the increased mortality of critically ill patients 25,26. Previously, it has been shown that the BChE activity correlates with the albumin concentration in critically ill patients with severe systemic inflammation 7. However, in the present study, no correlation was observed between albumin concentration and the BChE activity in trauma patients.…”

“…Altered serum BChE activity might indicate a disrupted Ach hydrolysis, which would, in turn, indirectly signal an imbalance between the pro- and anti-inflammatory systemic responses mediated by nonneuronal cholinergic activity 4,6. Previously, it has been shown that patients diagnosed with severe systemic inflammation show a marked reduction in the activity of serum cholinesterase 7. However, due to the high variability in the onset and etiology of the observed conditions, it was difficult to determine whether the change in the enzyme activity correlated with the emergence of the disease.…”

AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

“…Interestingly, these authors showed that a decrease in AChE-activity could be detected much earlier than other conventional laboratory tests generally used to diagnose sepsis (e.g. development of lactic acidosis) (22,36,37). The assumption that the decrease in AChE-activity is an early indicator of sepsis could not be con rmed in the results of the present study.…”

“…The measurement of the AChE-activity is based on the modi ed Ellman method, a colorimetric method, improved by Worek et al (28). The literature based reference values of AChE-activity ranges from 26.7 U/gHb until 50.9 U/gHb (36,37). Due to a high inter-and intra-individual variability of AChE-activity, in clinical practice, a modi ed reference range from 30.0 to 50.0 U/gHb is more suitable (29).…”

“…However, unlike AChE-activity, it is not a surrogate for central cholinergic transmission (45). BChE-activity correlates inversely with the C-reactive protein and could be a predictor for the outcome of various diseases (37,44). Overall, BChE-activity appears to re ect the in ammatory level, while AChEactivity may indicate a change in central cholinergic transmission.…”