Serum cholinesterase activity reflects morbidity in burned patients
Introduction
There are only a few published studies on the serum cholinesterase activity in burned patients. Price et al. [1] demonstrated that the loss of serum cholinesterase activity was in association with different symptoms, such as anxiety, emotional liability, muscle twitching, respiratory muscle weakness and dyspnoea. Furthermore, these authors postulated a low level of serum cholinesterase activity as a cause for respiratory failure.
Frolich [2] also mentioned the abated level of CHE as one of the possible factors for dyspnoea and cyanosis in burned patients. Viby-Mogensen et al. [3] described the magnitude as well as the rate of fall of the CHE in burned patients. The mean cholinesterase was found to be correlated with the severity of the thermal injury.
These authors concluded that the decrease in serum cholinesterase activity is based on:
- 1.
decreased enzyme synthesis or release from the liver due to hepatocellular damage;
- 2.
an initial dilution effect due to fluid therapy;
- 3.
increased catabolism;
- 4.
increased transcapillary loss.
Al-Kassab and Vijayakumar [5] postulated the serum cholinesterase as a sensitive indicator of hepatic dysfunction in systemic sepsis syndrome, a significant correlation of the concentration of CHE activity and clinical outcome was found, the mean level in patients who died was significantly lower in comparison to those who survived.
The aim of this study was to evaluate the diagnostic usefulness of serial determination of serum cholinesterase activity in patients with severe burn injuries. One of the main objectives was to detect, if this parameter is a clinically relevant co-factor to determine the severity of a burn injury and thereby its impact on the morbidity of the patient.
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Material and methods
Two hundred consecutive patients (31.4% female and 68.6% male) admitted to our ward due to severe burn injuries (mean ABSI: 7, mean BSA: 31.75%) were investigated during the last 2 years, the mean age of the patients was 52.5 years.
The population of patients was divided into two groups: one group included 50 non-survivors. The other group included 150 survivors, their details are presented in Table 1.
Results
Fig. 1 shows the levels of the serum cholinesterase in both groups in relation to the time after injury.
In the group of non-survivors, there was a statistical significant decrease in cholinesterase activity between Day 0 versus following time points: Day 1 (P<0.000017), Day 3 (P<0.000017), Day 5 (P<0.000017), Day 7 (P<0.000017).
In the group of the survivors, there was also a statistically significant decrease in cholinesterase activity between Day 0 versus following time points: Day 1 (P
Discussion
Reviewing the literature showed that lot of disorders, such as liver diseases, malnutrition, severe acute infections and severe burns are associated with the deficiency of serum cholinesterase activity [1], [2], [3], [4], [7], [8]. The changes of serum cholinesterase activity in burned patients were published by some authors. Price et al. [1] demonstrated that the loss of serum cholinesterase activity was in context with different symptoms, like anxiety, emotional liability, muscle twitching,
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Point-of-care measured serum cholinesterase activity predicts patient outcome following severe burns
2021, BurnsCitation Excerpt :Acetylcholine (ACh) is the primary transmitter for cholinergic anti-inflammatory signalling [5–7] and serum cholinesterase (butyrylcholinesterase, BChE also known as ChE or pseudocholinesterase) is the major non-neuronal ACh-hydrolyzing enzyme [9,10]. Conventionally measured BChE activity has been described as clinically relevant biomarker, correlating with injury severity and morbidity of burned patients [11–14]. In 2002, Kamolz et al. proposed to include BChE measurements in the early estimation of burn injury severity to improve risk stratification [11,12].
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