Serum Total Cholinesterase Activity on Admission Is Associated with Disease Severity and Outcome in Patients with Traumatic Brain Injury

Abstract

BackgroundTraumatic brain injury (TBI) is one of the leading causes of neurological disability. In this retrospective study, serum total cholinesterase (ChE) activities were analyzed in 188 patients for diagnostic as well as predictive values for mortality.Methods and FindingsWithin 72 hours after injury, serum ChE activities including both acetylcholinesterase and butyrylcholinesterase were measured. Disease severity was evaluated with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score, length of coma, post-traumatic amnesia and injury feature. Neurocognitive and functional scores were assessed using clinical records. Of 188 patients, 146 (77.7%) survived and 42 (22.3%) died within 90 days. Lower ChE activities were noted in the non-survivors vs. survivors (5.94±2.19 vs. 7.04±2.16 kU/L, p=0.023), in septic vs. non-infected patients (5.93±1.89 vs. 7.31±2.45 kU/L, p=0.0005) and in patients with extremely severe injury vs. mild injury (6.3±1.98 vs. 7.57±2.48 kU/L, p=0.049). The trajectories of serum ChE levels were also different between non-survivors and survivors, septic and non-infected patients, mild and severely injured patients, respectively. Admission ChE activities were closely correlated with blood cell counts, neurocognitive and functional scores both on admission and at discharge. Receiver operating characteristic analysis showed that the area under the curve for ChE was inferior to that for either APACHE II or white blood cell (WBC) count. However, at the optimal cutoff value of 5 kU/L, the sensitivity of ChE for correct prediction of 90-day mortality was 65.5% and the specificity was 86.4%. Kaplan-Meier analysis showed that lower ChE activity (<5 kU/L) was more closely correlated with poor survival than higher ChE activity (>5 kU/L) (p=0.04). After adjusting for other variables, ChE was identified as a borderline independent predictor for mortality as analyzed by Binary logistic regression (P=0.078).ConclusionsLowered ChE activity measured on admission appears to be associated with disease severity and outcome for TBI patients.

Serum Butyrylcholinesterase Activity: A Biomarker for Parkinson’s Disease and Related Dementia

“…In conclusion, BChE activity can be regarded as a biomarker in PD, especially in PD-related dementia. The same function has also been reported in other disorders, including Alzheimer's disease [ 11 ], vascular dementia [ 25 ], ischemic stroke [ 26 ], traumatic brain injury [ 7 ], postoperative delirium [ 27 ], severe trauma [ 28 ], septic shock [ 29 ], burn injuries [ 30 ], adverse cardiac events [ 16 ], hepatic disease [ 17 ], diabetes [ 31 ], and hyperlipidemia [ 32 ]. A former study on AChE levels in PD patients suggested that polymorphisms in ACHE genes fail to initiate ACHE expression, resulting in an impaired Ach/DA balance and subsequent vulnerability of dopaminergic neurons and PD development [ 9 ].…”

“…It is a key contributor to stress and enhances neuronal excitability. In addition, it also potently modulates the classical immune response by activating α 7 nicotinic Ach receptor on the surface of leukocytes in the so-called “cholinergic anti-inflammatory response” [ 7 ]. The cholinergic system is involved in many physiological functions of the central nervous system, and Ach can be hydrolyzed by acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), two independent enzymes in the circulation system.…”

“…Serum BChE is mainly synthesized in the liver and can be clinically used as a marker of organophosphate poisoning [ 8 ]. However, increasing evidence suggests that BChE activity is also associated with disease severity and can be used to predict prognosis in many diseases [ 7 ]. Although AChE activity reportedly decreases in Parkinson's disease [ 9 ], the relationship between BChE activity and Parkinson's disease had not been clearly performed.…”

Sepsis-associated encephalopathy: a vicious cycle of immunosuppression

“…Dysfunction of the CAP is also commonly complicated in severe septic condition, as evidenced by a massive loss of brain cholinergic neurons and vagal tone together with disturbed responses of Ach-α7nAchR machinery, which fails at inhibiting inflammation and protecting organs [14,112,113]. A close relationship has been noted between poor outcomes and indicators of CAP malfunction, such as a decrease in heart rate variability, an increase in cholinesterase activity, and downregulation of α7nAchR mRNA expression in peripheral immune cells [113][114][115]. Manipulation of CAP activity through stimulating brain cholinergic nuclei or vagus nerve, inhibiting cholinesterase activity and administering agonists of α7nAchR, is beneficial for organ function and survival of septic animals by reconstruction or simulation of CAP effects [9,10,116,117].…”

Combination of plasma exchange and haemofiltration for treating thrombotic microangiopathy in children

“…Due to the retrospective design of this current study, the PCIS data can only be presented with a translated supplementary table as a reference. Cholinesterase has been reported as a prognostic or severity marker for several diseases, including severe injury, 21 sepsis, 22 dementia, 23 and acute organophosphate pesticide poisoning. 24 LDH and a-HBDH levels are associated with renal damage and infection.…”