Abstract
Low serum cholinesterase (SCHE) activity has been associated with poor prognoses in a variety of conditions, including sepsis. However, such an association has not been well characterized since the Third International Consensus Definitions Task Force modified the definition of sepsis to “life-threatening organ dysfunction due to a dysregulated host response to infection” (known as sepsis-3) in 2016. In the current retrospective cohort study, we examined whether 30-day mortality in sepsis-3 patients is associated with SCHE activity. A total of 166 sepsis-3 patients receiving treatment at an emergency intensive care unit (EICU) were included. The 30-day death rate was 33.1% (55/166). SCHE activity upon EICU admission was lower in nonsurvivors (3.3 vs. 4.5 KU/L in survivors, p = 0.0002). Subjects with low SCHE activity (defined as <4 KU/L) had higher 30-day mortality rates than subjects with normal SCHE activity (45.5%, 40/88 vs. 19.2%, 15/78; p<0.001). A multivariate logistic regression analysis revealed an association between 30-day mortality and lower SCHE activity after adjustments for relevant factors, such as acute multiple organ dysfunction. The odds ratio (OR) for every unit decrease in SCHE activity was 2.11 (95% confidence interval (CI), 1.37–3.27; p = 0.0008). The area under the curve (AUC) of SCHE activity for predicting 30-day mortality was 0.67 (95% CI 0.59–0.74), and the AUC of lactate for predicting 30-day mortality was 0.64 (95% CI 0.57–0.70). Using a combination of SCHE and lactate, the AUC was 0.74 (95% CI 0.69–0.83). These data suggest that lower SCHE activity is an independent risk factor for 30-day mortality in sepsis-3 patients.
Highlights
Serum cholinesterase (SCHE; known as pseudo- or butyryl-cholinesterase) is a performance metric of liver function, with lower activity reflecting more extensive liver injury [1]
Eleven patients admitted to the emergency intensive care unit (EICU) more than 10 days after the initial suspicion of sepsis were excluded
After excluding the comorbid conditions listed in the exclusion criteria in the Methods section, a total of 166 patients were included in the data analysis
Summary
Serum cholinesterase (SCHE; known as pseudo- or butyryl-cholinesterase) is a performance metric of liver function, with lower activity reflecting more extensive liver injury [1]. Decreased SCHE activity has been associated with severity and mortality in critically ill patients [2,3,4,5,6,7,8], with varying prognostic values for different diseases [9]. The third International Consensus Definitions Task Force modified the definition of sepsis to “life-threatening organ dysfunction due to a dysregulated host response to infection”. Serum cholinesterase activity and 30-day mortality in sepsis-3 patients (known as sepsis-3) in 2016 [16, 17]. The modified definition included organ dysfunction as a fundamental aspect of sepsis [18]. Whether SCHE activity is associated with shortterm survival under this new definition is unclear
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