Serum cholinesterase activity reflects morbidity in burned patients

doi:10.1016/S0305-4179(01)00091-2

Burns

Volume 28, Issue 2, March 2002, Pages 147-150

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Abstract

Blood samples of 200 patients with thermal injuries were drawn apparently to determine the trend of the cholinesterase activity. In relation to the severity of the injury, a characteristic decrease was noted during the first days after admission. A recovery to normal values was achieved in all survivors (150 patients) after a proportionate period of time, but in the group of non-survivors (50 patients), no complete recovery to normal levels was found. Furthermore, a significant relationship between serum cholinesterase activity and the severity of morbidity was detected, the fall of the cholinesterase activity at the very beginning was significantly higher (P<0.004) in patients who died (1.3 kU/l) than in patients who survived (0.7 kU/l). Already 24 h after admission, the mean activity was significantly lower (P<0.003) in non-survivors (2.5 kU/l) than in survivors (3.2 kU/l). It seems that the serum cholinesterase is a sensitive indicator for the morbidity of patients with severe burn injuries.

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.

Section snippets

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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Citation Excerpt :
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Serum cholinesterase activity reflects morbidity in burned patients

Abstract

Introduction

Section snippets

Material and methods

Results

Discussion

Am. J. Surg.

Burns

Burns

Ann. Emerg. Med.