A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis
Early sepsis identification is of paramount importance for an effective therapy and the patient outcome; however, a suitable prognostic biomarker is lacking. Anti-inflammatory nonneuronal cholinergic signaling modulates the magnitude of an immune response. Serum cholinesterase (BChE), an enzyme that...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Mediators of Inflammation |
| Online Access: | http://dx.doi.org/10.1155/2018/1942193 |
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| author | Aleksandar R. Zivkovic Sebastian O. Decker Anne C. Zirnstein Annette Sigl Karsten Schmidt Markus A. Weigand Stefan Hofer Thorsten Brenner |
| author_facet | Aleksandar R. Zivkovic Sebastian O. Decker Anne C. Zirnstein Annette Sigl Karsten Schmidt Markus A. Weigand Stefan Hofer Thorsten Brenner |
| author_sort | Aleksandar R. Zivkovic |
| collection | DOAJ |
| description | Early sepsis identification is of paramount importance for an effective therapy and the patient outcome; however, a suitable prognostic biomarker is lacking. Anti-inflammatory nonneuronal cholinergic signaling modulates the magnitude of an immune response. Serum cholinesterase (BChE), an enzyme that hydrolyzes acetylcholine, plays an important role during inflammatory response and serves as an accurate index of cholinergic activity. BChE activity was measured in septic patients using a point-of-care system, and levels of conventional inflammatory markers and the disease severity scores were obtained. We observed a strong, sustained reduction in BChE activity in patients who died within a 90-day observation period, as compared to survivors. Reduced BChE activity when measured at the ICU admission effectively differentiated between the 90-day survivor and the nonsurvivor patient groups. We estimated a critical BChE level of 1.661 kU/L (CI 0.5–0.8, 94% sensitivity, 48% specificity, AUC 0.7) to best predict patient outcome providing a benchmark criterion for early detection of potentially fatal sepsis measured at the admission. This finding suggests that the BChE activity, used in combination with the laboratory tests, clinical examination, and the disease severity scoring, could serve to identify high-risk patients at the ICU admission, the most critical time point in the sepsis treatment. |
| format | Article |
| id | doaj-art-e71817fdf2924e6aa8dec619672dcdf3 |
| institution | Kabale University |
| issn | 0962-9351 1466-1861 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Mediators of Inflammation |
| spelling | doaj-art-e71817fdf2924e6aa8dec619672dcdf32025-02-03T01:27:37ZengWileyMediators of Inflammation0962-93511466-18612018-01-01201810.1155/2018/19421931942193A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following SepsisAleksandar R. Zivkovic0Sebastian O. Decker1Anne C. Zirnstein2Annette Sigl3Karsten Schmidt4Markus A. Weigand5Stefan Hofer6Thorsten Brenner7Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Heidelberg, GermanyEarly sepsis identification is of paramount importance for an effective therapy and the patient outcome; however, a suitable prognostic biomarker is lacking. Anti-inflammatory nonneuronal cholinergic signaling modulates the magnitude of an immune response. Serum cholinesterase (BChE), an enzyme that hydrolyzes acetylcholine, plays an important role during inflammatory response and serves as an accurate index of cholinergic activity. BChE activity was measured in septic patients using a point-of-care system, and levels of conventional inflammatory markers and the disease severity scores were obtained. We observed a strong, sustained reduction in BChE activity in patients who died within a 90-day observation period, as compared to survivors. Reduced BChE activity when measured at the ICU admission effectively differentiated between the 90-day survivor and the nonsurvivor patient groups. We estimated a critical BChE level of 1.661 kU/L (CI 0.5–0.8, 94% sensitivity, 48% specificity, AUC 0.7) to best predict patient outcome providing a benchmark criterion for early detection of potentially fatal sepsis measured at the admission. This finding suggests that the BChE activity, used in combination with the laboratory tests, clinical examination, and the disease severity scoring, could serve to identify high-risk patients at the ICU admission, the most critical time point in the sepsis treatment.http://dx.doi.org/10.1155/2018/1942193 |
| spellingShingle | Aleksandar R. Zivkovic Sebastian O. Decker Anne C. Zirnstein Annette Sigl Karsten Schmidt Markus A. Weigand Stefan Hofer Thorsten Brenner A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis Mediators of Inflammation |
| title | A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis |
| title_full | A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis |
| title_fullStr | A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis |
| title_full_unstemmed | A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis |
| title_short | A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis |
| title_sort | sustained reduction in serum cholinesterase enzyme activity predicts patient outcome following sepsis |
| url | http://dx.doi.org/10.1155/2018/1942193 |
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