Serum Cholinesterase Levels Research Articles

Expression of Cholinesterase in Bone Tumors, Blood and Cord Blood

The present study aimed to analyze Cholinesterase (CE) levels in cord blood from preeclamptic women and to evaluate cholinesterase status in patients with osteosarcoma. Serum cholinesterase levels were assessed in 30 cases of osteosarcoma and 30 controls suffering from musculoskeletal pain. Additionally, maternal and cord blood samples were collected from 25 women with preeclampsia and compared with those from 25 normotensive pregnant women and 25 normal, healthy controls. The results indicated that serum cholinesterase levels were significantly lower in osteosarcoma patients (Group I) compared to those with musculoskeletal pain (Group II, p < 0.05). Similarly, cholinesterase levels were reduced in the maternal blood of women with preeclampsia when compared to normotensive controls. Cord blood cholinesterase levels were lower in the infants of normotensive mothers, with levels reaching 88.65% of the maternal levels. Furthermore, cord blood cholinesterase levels were significantly lower in preeclamptic women compared to normotensive pregnant women. When comparing cholinesterase levels to those of normal controls, it was observed that CE levels were significantly elevated in both normotensive and preeclamptic women. The findings of low serum cholinesterase levels in this study suggest that cholinesterase secreted by osteoblasts is utilized in bone formation and tumorigenesis. Additionally, the decrease in cholinesterase levels associated with preeclampsia may be linked to the loss of muscarinic cholinergic receptors that occur in this condition.

Clinical impact of serum cholinesterase level on clinical outcomes in patients with lower extremity artery disease undergoing endovascular treatment

Abstract Background Cholinesterase (ChE) has been used to be an indicator of the protein synthesis ability in the liver and nutritional status. Recent findings have identified low ChE levels as a prognostic factor for heart failure. However, the relationship between serum ChE levels and clinical outcomes in patients with lower extremity artery disease (LEAD) undergoing endovascular treatment (EVT) remains unclear. Purpose This study aimed to investigate the association between pre-procedure serum ChE levels and clinical outcomes in LEAD patients undergoing EVT. Methods The subjects were 283 consecutive LEAD patients who underwent EVT at our University Hospital were included. The primary outcome measure was the cumulative incidence of major adverse cardiovascular events (MACEs) within two years, defined as the composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. Results The mean age of the cohort was 72.6±10.6 years, with 67.5% being male. Within two years, 45 patients experienced MACE, and Kaplan-Meier curves demonstrated the cumulative incidence of MACE within two years was 19.3%. Receiver operating characteristic curve analysis showed that serum ChE was a univariable factor that predicted MACE within two years with moderate accuracy (area under the curve = 0.693, 95% confidence interval (CI) 0.615–0.771), with an optimal serum ChE cutoff level of 284 units/L. According to the optimal cut-off value, patients were divided into low ChE (ChE ≤ 284 units/L, N=189) and high ChE ((ChE > 284 units/L, N=94) groups. In the baseline characteristics between the two groups, age was significantly higher in the low ChE groups than in the high ChE group. There were no significant differences in gender, the prevalence of diabetes mellitus, hypertension, and the proportions of previous stroke, and previous myocardial infarction between the two groups. In contrast, the proportions of hemodialysis (HD) and chronic limb-threatening ischemia (CLTI) were higher in the low ChE groups. Kaplan-Meier curves demonstrated a significantly higher cumulative incidence of MACE in the low ChE group compared to the high ChE group (log-rank p < 0.001). In multivariate analysis using Cox proportional hazards models adjusting for risk factors, including HD and CLTI, low ChE group was independently associated with MACE (low ChE group: hazard ratio (HR) 4.24, 95% confidence interval (CI) 1.24-14.49, p=0.021). In addition, Cox proportional hazards models using serum ChE level and HD revealed that patients with both low-ChE and HD showed a greater risk of MACE (HR 15.19; 95% CI 3.60–64.02; P < 0.001) after EVT as compared to patients with neither low-CHE nor HD. Conclusions In LEAD patients undergoing EVT, lower ChE levels were independently associated with a higher risk of MACE, regardless of HD. Assessment of serum ChE level may provide insights into identifying high-risk LEAD patients who need careful attention after EVT.

Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant Acinetobacter baumannii Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients' Prognosis.

Background: Multidrug-resistant Acinetobacter baumannii (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality in patients with CRAB infections being treated with Cefiderocol. Methods: We carried out an observational pilot study on consecutive patients hospitalized in the ICU with ensuing septic Acinetobacter baumannii infections treated with Cefiderocol monotherapy or Cefiderocol including combinations. We investigated the predictive power of lymphocyte counts, lymphocyte subpopulations, serum cholinesterase levels, and reactivation of herpes viruses. Results: Overall, 36 of 39 patients entered in our analysis: 20 survivors and 16 deceased. A total of 12 patients developed bacteremia, 19 patients had HAP/VAP, and 5 patients had a soft tissue infection. Univariate analyses of factors associated with unfavorable outcome revealed a significant association for age (OR: 1.5, CI: 1.11-2.02), SAPS II (OR: 1.05, CI: 1.01-1.1), SOFA score (OR: 1.37, CI: 1.06-1.76), lymphocytopenia (OR: 32.5, CI: 3.45-306.4), viral reactivation (OR: 9.75, CI: 1.72-55.4), and cholinesterase drop <1600 U/L (OR: 39.7, CI: 5.8-271.6). At variance, monotherapy or associations with Cefiderocol were not associated. In the final multivariable model, the only independent predictors of death were age (OR: 1.42, CI: 0.98-2.05), lymphocytopenia (OR: 18.2, CI: 0.87-371), and cholinesterase drop to below 1600 U/L (OR: 9.7, CI: 0.77-123.7). Conclusions: Age, lymphocytopenia, and serum cholinesterase drops, which were nearly significantly associated with an unfavorable outcome, may help pinpoint patients with acute immune paralysis during sepsis. Knowledge of such an immune state may in turn directly influence patients' care.

Knowledge, Attitude and Practices of Pesticides Use and Serum Cholinesterase Level Among Farm Workers in Bhaktapur – A Cross Sectional Study

Abstract Introduction/Objective Pesticides use has been an integral part of modern agricultural practices. Lack of knowledge and unsafe handling of pesticides uses have kept the farm workers in the frontline of vulnerability. Serum cholinesterase show a dose-exposure relationship with organophosphorus. This study aims to identify the existing knowledge, attitude and practices of pesticides use among farm workers and to measure the serum cholinesterase level before and after spraying of the pesticides. Methods/Case Report This is a cross-sectional study carried out among farm workers of Madhyapur Municipality, Bhaktapur, Nepal. Ethical clearance was obtained from Nepal Health Research Council, Nepal. House hold survey was carried out for the knowledge, attitude and practices of pesticides use using structured questionnaires. Written consent was taken. Blood was collected twice, before and after spraying season for 97 farm workers. Serum cholinesterase was analyzed in the vitros 4600 biochemistry analyzer. Paired t-tests and chi square tests were used for statistical analysis. Results (if a Case Study enter NA) The mean cholinesterase of farm workers before and after pesticide spraying was 6.92±1.47 U/mL and 6.49±1.47 U/mL respectively, with p value of &amp;lt;0.001. There were also significant differences of serum cholinesterase level among farm workers before and after pesticide spraying on the basis of education level, type of involvement either full time or part time and prior integrated pest management training. This study found that 63% of respondents had good knowledge on pesticides while 25% had average and 12% had poor knowledge. Similarly, this study also found that 54% of respondents had good knowledge on pesticides use while 26% had average and 20% had poor knowledge. However, this study showed that only 44% of farm workers had good practice. Association between knowledge of pesticide and practices and between knowledge of pesticides use and practices were statistically significant with p-value of 0.001 and 0.001 respectively. Conclusion There is a significant difference in the level of serum cholinesterase before and after spraying pesticides in farm workers. Lack of education, lack of integrated pest management training and poor practices of pesticides use are the reasons behind the difference in the serum cholinesterase level.

A novel BCHE frameshift mutation in a Chinese woman with butyrylcholinesterase deficiency: A case report and literature review.

Congenital butyrylcholinesterase deficiency (BCHED) is a rare autosomal recessive genetic disorder caused by a pathogenic mutation in the BCHE gene. Patients with BCHED may experience prolonged apnea or even death after the application of drugs such as succinylcholine. We aimed to identify the genetic basis of disease in a patient presenting with butyrylcholinesterase deficiency in order to confirm the diagnosis, expand BCHE gene mutation spectrum, and elucidate potential genotype-phenotype associations to inform management. A 51-year-old woman presented with "vague pain in the upper and middle abdomen." Her serum cholinesterase level was 211 U/L (reference value 4000-13,000 U/L). Other laboratory findings were normal. Genetic analysis revealed compound heterozygous mutations in BCHE gene, which was considered pathogenic in this case. The patient presented with low serum cholinesterase levels, which excluded common causes such as liver disease, drug toxicity, and chronic illness. Whole exon examination revealed compound heterozygous mutations in the BCHE gene; thus, the patient was diagnosed with congenital BCHED. Gastroscopy without succinylcholine or mivacurium chloride was recommended. The gastroscopy results were "gastric polyps," and gastroscopic "polypectomy" was performed. The patient was advised to avoid succinylcholine use. The patient's serum cholinesterase level was reviewed 3 months later, and the result was 215 U/L. Double heterozygous mutations are the cause of BChE deficiency of this woman in this study, including a novel mutation NM_000055.4: c.666_669del (p.Phe223Glufs*38). A review of the literature reveals considerable variation in the hotspot variants of the BCHE gene across different populations. The Chinese population displays a higher prevalence of the silent type, which is more sensitive to anesthetics such as succinylcholine. Clinical manifestations of congenital BCHED were not significant. This study avoided a potential anesthetic accident, and the novel variant enriched the BCHE gene mutation spectrum.

Impact of serum cholinesterase on calcified nodules in patients with stable coronary artery disease.

Calcified nodules (CNs) are an advanced stage of coronary calcification that can have significant clinical implications. We investigated factors associated with CNs, the etiology of which is not fully understood. We retrospectively evaluated 619 patients with stable coronary artery disease who underwent intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI). CNs in the culprit lesion were evaluated via IVUS, and all-cause mortality and major cardiovascular and cerebrovascular events (MACCEs) were compared between the CN and non-CN groups. The CN group (n = 40 patients) had a significantly lower survival rate and a higher incidence of MACCE than the non-CN group (P = 0.020 and P < 0.001, respectively). Multivariate logistic regression analysis models revealed that chronic kidney disease and serum cholinesterase (ChE) level were associated with CN formation [odds ratio (OR): 3.15, 95% confidence interval (CI): 1.30-7.69, P = 0.001 and OR: 0.94, 95% CI: 0.88-0.99, P = 0.042]. The optimal cutoff of serum ChE level as per the receiver operating characteristic curve was 309 units/l (Area under the curve = 0.67, sensitivity = 93%, specificity = 40%, P = 0.001). The low-ChE group divided according to the optimal cutoff value showed significantly higher cumulative incidence of MACCEs after PCI than the high-ChE group as per Kaplan-Meier analysis. The presence of CNs is significantly associated with a poor prognosis and MACCE after PCI among patients with stable coronary artery disease. Serum ChE levels may affect CN formation.

Cholinesterase as a predictor of skeletal muscle loss after gastrectomy for gastric cancer.

Cholinesterase is a classical nutritional and inflammatory marker. The aim of the present study was to evaluate the value of cholinesterase as a predictive marker for postoperative skeletal muscle loss after gastrectomy for gastric cancer. The study comprised 68 patients who had undergone gastrectomy for gastric cancer. Skeletal muscle mass was evaluated using skeletal mass index, and major skeletal muscle loss was defined as less than or equal to the median change rate (1-year postoperative/preoperative) of skeletal mass index in all patients. We explored the relationship between postoperative major skeletal muscle loss and disease-free survival and overall survival. Then we investigated the relationship between change rate of skeletal muscle index and serum cholinesterase levels after gastrectomy. The median value of change rate of skeletal mass index was 0.93. Postoperative major skeletal muscle loss was significantly associated with disease-free survival after gastrectomy (P=0.003). Although major skeletal muscle loss had worse overall survival, it was not significant (P=0.058). The change rate of skeletal mass index and cholinesterase had a stronger positive correlation compared with other nutritional indices according to Spearman's rank correlation coefficient (r=0.438, P≤0.001). Evaluation of serum cholinesterase levels may be valuable for predicting postoperative skeletal muscle loss after gastrectomy, suggesting the importance of cholinesterase in postoperative nutritional management of patients with gastric cancer.

Study of Levels of Creatine Phosphokinase and Lactate Dehydrogenase as Prognostic Markers in Acute Organophosphorus Poisoning

Objectives: Organophosphorus compound (OPC) poisoning is primarily a problem in developing countries. Its widespread use and easy availability have increased the likelihood of poisoning with these compounds. Serum cholinesterase levels are easier to estimate and usually depressed after organophosphorus (OP) poisoning. Peradeniya OP poisoning scale has not been studied much in the Indian scenario. It could be a simple and effective system to determine the need for ventilatory support early on in the course. Hence, this study was undertaken to assess the severity of OPC poisoning clinically using Peradeniya scoring and by estimating creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) levels. Material and Methods: A prospective observational study was performed among 100 cases of OP poisoning from January 2021 to October 2022. On patient’s fulling, inclusion criteria were investigated with serum acetylcholinesterase at the time of admission, and periodic estimation of serum CPK and serum LDH was done on the day of admission and then on day three and day 5 of admission Results: The CPK and LDH levels were significantly elevated in patients who developed respiratory failure and thus strongly correlated with clinical severity Conclusion: Serum CPK and LDH show a strong degree of positive correlation with the severity of poisoning and can be used as a predictor of outcome in OP poisoning.

Knowledge, attitude and practices of pesticides use and serum cholinesterase level among farm workers in Bhaktapur – A cross sectional study

Knowledge, attitude and practices of pesticides use and serum cholinesterase level among farm workers in Bhaktapur – A cross sectional study

Preoperative serum cholinesterase as a prognostic factor in patients with colorectal cancer.

Serum cholinesterase (ChE) levels are considered to reflect nutritional status. Although ChE has been well documented as a prognostic factor for some cancers, no clear consensus on its use for colorectal cancer (CRC) has been reached. The aim of this study was to investigate the relationship between preoperative serum ChE and postoperative long-term prognosis in CRC patients. A total of 1053 CRC patients who underwent curative surgery were included in this study. The correlations between the preoperative ChE value and overall survival (OS) or cancer-specific survival (CSS) were assessed. By dividing patients into two groups according to their ChE value, OS and CSS were compared between the groups. Multivariate analysis revealed that the continuous ChE value was a significant predictor of OS (hazard ratio, 0.996; 95% CI, 0.993-0.998; p = 0.002) and CSS (hazard ratio, 0.994; 95% CI, 0.991-0.998; p = 0.001), independent of other variables. The low-ChE (≤234 U/L) group had a significantly poorer prognosis than the high-ChE (>234 U/L) group for both OS (5-year OS for low ChE and high ChE: 79.8% and 93.3%, respectively; p < 0.001) and CSS (5-year CSS for low ChE and high ChE: 84.8% and 95.6%, respectively; p < 0.001). Lower preoperative serum ChE levels are a predictive factor of poor prognosis for CRC patients. As serum ChE levels can be measured quickly and evaluated easily, ChE could become a useful marker for predicting the postoperative long-term outcomes of CRC patients.

Use of the Serum Level of Cholinesterase as a Prognostic Marker of Nonfatal Clinical Outcomes in Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) contributes to a poor prognosis. Reliable biomarkers to predict adverse outcomes during hospitalization are important. To investigate the relationship between the serum cholinesterase (ChE) level and adverse clinical outcomes, including hypoxemia severity, hypercapnia, duration of hospital stay (DoHS), and noninvasive ventilation (NIV) requirement, in patients with AECOPD. Patients hospitalized with AECOPD in the Wuhu Hospital of Traditional Chinese Medicine between January 2017 and December 2021 were included. A total of 429 patients were enrolled. The serum ChE level was significantly lower in patients with hypercapnia, who required NIV during hospitalization and who had a DoHS of >10 days, with an oxygenation index < 300. The ChE level was correlated negatively with the C-reactive protein level and neutrophil-to-lymphocyte ratio and correlated positively with the serum albumin level. Multivariate logistic regression analysis indicated that a serum ChE level of ≤4116 U/L (OR = 2.857, 95% CI = 1.46-5.58, p = 0.002) was associated significantly with NIV requirement. The serum ChE level was correlated significantly with complicating severe hypoxemia, hypercapnia, prolonged DoHS, and the need for NIV in patients hospitalized with AECOPD. The serum ChE level is a clinically important risk-stratification biomarker in patients hospitalized with AECOPD.

The Association Between QTc-Interval and Blood Glucose with Plasma Acetylcholinesterase in Organophosphate (OP)-Poisoned Patients

Background: Organophosphate (OP) poisoning ranks among the leading causes of poisoning, morbidity, and mortality in developing countries due to its relatively high prevalence and potentially grave outcomes. Consequently, it is crucial to identify an easily accessible and cost-effective marker that can be utilized across healthcare facilities. Objectives: This study aimed to explore the relationship between the QTc interval and blood glucose levels with serum cholinesterase levels in patients poisoned by organophosphates. Methods: The sample consisted of all patients admitted with OP poisoning to a Northwest Poisoning Center in Iran during 2016 and 2017. Diagnosis of OP poisoning was confirmed through patient history, physical examination, or the measurement of acetylcholinesterase levels. Data collected were analyzed using SPSS software version 25. Results: Out of 238 patients, 104 remained after applying exclusion criteria and were included in the study. The mean age of these patients was 30.81 ± 15.04 years. A statistically significant negative correlation was found between average blood glucose and serum cholinesterase levels (P = 0.046, Pearson Correlation = -0.196). Furthermore, patients with abnormal QTc intervals exhibited significantly lower serum cholinesterase levels (P &lt; 0.001). Conclusions: The findings indicate a significant association between QTc intervals and blood glucose levels with serum cholinesterase levels. Serum cholinesterase levels decreased with an increase in QTc intervals and blood glucose levels. Specifically, patients with a QTc interval greater than 440 milliseconds or random blood glucose levels above 200 milligrams per deciliter showed significantly lower serum cholinesterase levels.

THE Point prevalence of acetylcholinesterase inhibition, neuropathy and safety awareness among flower farm workers in naivasha, nakuru county, kenya.

Acetyl cholinesterase catalyses the hydrolysis of acetylcholine in the nerve synapses, thereby terminating nerve impulse, however, it is inhibited by organophosphates and carbamates. This study aimed to assess the level of acetyl cholinesterase inhibition and the resultant neuropathy in flower farm workers as well as the farmers’ awareness of safety measures and predisposing factors while handling pesticides. A cross-sectional study was conducted involving 217 participants from different flower farms. Structured questionnaire was used to collect data to assess level of safety and predisposing awareness and to assess for neuropathy. Blood samples were collected to determine the cholinesterase levels using spectrophotometry technique at 405 nm. The mean serum cholinesterase level in flower farm workers in Naivasha was 5873.26 U/L. There was a positive correlation (R= 0.07) between the numbers of years worked in the industry and serum cholinesterase levels as shown by Karl Pearson`s coefficient. The point prevalence of cholinesterase inhibition in Naivasha was 14% indicating a significant risk of adverse health effects. The level of safety awareness and predisposing factors among workers on pesticide exposure was 65%, suggesting that while the majority of workers had some level of safety awareness, there is still room for improvement. The point prevalence of neuropathy was 38% of the participants presenting with varying symptoms of adverse effects of pesticide exposure. Musculoskeletal impairment was leading at 19.81%, followed by skin irritation at 13.36%.These findings highlighted the need for better safety measures and awareness campaigns in the flower farm industry to reduce the risk of acetyl cholinesterase inhibition.

Associations between pesticide exposure with biomarkers of stroke risk factors in farmers.

The extensive use of pesticides may cause acute and chronic intoxication. Therefore, this study aimed to reveal the associations between pesticide exposure and serum markers for stroke risk factors in farmers. A cross-sectional study was conducted with farmers, who used chemical pesticides in Seloprojo Village, Ngablak District, Magelang Regency, Central Java Province, Indonesia. A questionnaire containing demographics, pesticide use, and aspects related to work was employed. Measurements of serum cholesterol, uric acid, glucose, cholinesterase, and fibrinogen levels were also conducted. Of the 106 subjects, 31 (29.2%) used organophosphates as chemical pesticides. There was a significant difference between organophosphate and nonorganophosphate groups in plasma fibrinogen levels. The organophosphate group had higher levels of fibrinogen (292.29 ± 67.56 mg/dL) than the non-organophosphate group (255.24 ± 38.90 mg/dL). Of the studied risk factors for stroke, there is a significant association between organophosphate exposure and increased plasma fibrinogen levels.

The correlation between serum creatinine and burn severity and its predictive value.

This study aimed to explore the correlation between serum creatinine and burn severity and the value of predicting the outcome of patients. For this purpose, a total of 268 burn patients (BUP) were collected. According to the burn area, they were divided into mild group (MIG) (n = 125, burn area 30% - 49%), moderate group (MOG) (n = 80, burn area 50% - 79%) and severe group (SEG) (n = 63, burn area ≥ 80%). According to the prognosis, they were divided into survival group (SUG) (n = 170) and death group (DEG) (n = 98). At the same time, the control group (COG) was selected from the physical examination center of our hospital. 5 mL of fasting venous blood was collected from all BUP on the first, seventh, 14th and 21st days after admission. 5 mL of fasting venous blood was collected from the COG. Creatinine (CRE) level was measured by enzyme method. Cholinesterase (CHE) level in serum was measured by improved Ellman method. The changes of CRE and CHE in serum were compared among all groups to explore the correlation between serum creatinine and burn severity and its prediction Measure the value of patients' outcomes. Results showed that except for the first day after burn, the level of serum CRE in BUP was raised than that in the COG, and the level of serum CHE in BUP was reduced than that in the COG (P<0.05). The serum CHE level of BUP in all groups increased at first and then decreased, and the highest level was on the first day after injury. At the same time, the level of CRE in SEG was raised than that in MIG and MOG, and the level of CRE in MOG was raised than that in MIG (P<0.05). The serum CHE level of BUP in all groups decreased at first and then increased, and the lowest level was on the first day after injury. At the same time, the level of CRE in SEG was reduced to that in MIG and MOG, and the level of CRE in MOG was reduced to that in MIG (P<0.05). The level of CRE in serum of BUP in both groups increased at first and then decreased, and the level was the highest on the first day after injury. At the same time, the level of CRE in the DEG was raised than that in the SUG (P<0.05). The level of CHE in serum of BUP in both groups decreased at first and then increased, and the level was the lowest on the first day after injury. At the same time, the level of CRE in the death group was reduced than that in the SUG (P<0.05). Logistic regression analysis showed that there was statistical significance in the regression coefficients on the 1st, 7th, 14th and 21st day after burn, and on the 1st and 21st day after-burn. ROC curve analysis shows that CRE and CHE have certain value in diagnosing the prognosis of BUP, and the diagnostic value of CRE is higher. Cre level increases with the aggravation of burn patients, and ChE level decreases with the aggravation of BUP. In conclusion, Cre and ChE have certain value in diagnosing the prognosis of BUP and can be widely used in clinical practice.

Serum cholinesterase level provides the additional long-time prognostic information over AHEAD risk score in patients with acute decompensated heart failure with preserved ejection fraction

Abstract Background and purpose In patients with heart failure with preserved ejection fraction (HFpEF), comorbidities strongly influence the prognosis. AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score is a simple risk model based on several comorbidities. Its prognostic role has been reported in patients with HFpEF. Although malnutrition is one of the most important comorbidities, it is not included in AHEAD score. We previously reported the prognostic value of cholinesterase (CHE), which is a simple nutritional biomarker in daily practice, in patients with HFpEF. Here, we aimed to investigate whether serum CHE level provides the additional prognostic information over AHEAD risk score in patients with HFpEF. Methods We studied 888 patients admitted for acute decompensated heart failure (ADHF) in our multicenter-prospective HFpEF cohort study (PURSUIT-HFpEF registry). Laboratory data including CHE was obtained at discharge. We evaluated AHEAD risk score (range 0-5, atrial fibrillation, hemoglobin &amp;lt;13mg/dL for men and 12mg/dL for women, age &amp;gt;70years, creatinine &amp;gt;130μmol/L, and diabetes mellitus).The endpoint of this study was set as the composite of worsening heart failure readmission and all-cause mortality. Results During a follow up period of 1.6±1.3 years, 428 patients experienced primary composite endpoint. On multivariate Cox analysis, CHE (p&amp;lt;0.001) and AHEAD risk score (p = 0.003) were independently and significantly associated with primary composite endpoint. Kaplan-Meier analysis that patients with higher AHEAD risk score (defined as 4-5 point) and those with intermediate AHEAD score (defined as 2-3 point) had significantly greater risk of primary composite endpoint than those with low AHEAD score (defined as 0-1 point) (67% vs 54% vs 37%, log-rank p&amp;lt;0.001). Kaplan-Meier analysis in the subgroup with low AHEAD risk score revealed that primary composite event was significantly more frequently observed in patients with low CHE (&amp;lt;207 IU/L determined by the median of the whole cohort) (56% vs 28% p = 0.009). Moreover, in the subgroup with intermediate AHEAD risk score, the incidence of primary composite event was also significantly higher in patients with low CHE (56% vs 37% p&amp;lt;0.001). Finally, in the subgroup with high AHEAD risk score, the incidence of primary outcome was also significantly higher in patients with low CHE (69% vs 48% p&amp;lt;0.001). Receiver operating curve analysis showed that the addition of CHE significantly improved the risk prediction of AHEAD score (AUC: 0.641 vs 0.573, p&amp;lt;0.001). Conclusion Malnutrition, as evaluated by serum cholinesterase level, provided the additional long-time prognostic information beyond AHEAD risk score in patients with ADHF-HFpEF.

Association between serum cholinesterase and the prevalence of atrial fibrillation in Chinese hypertensive population: a cross-sectional study

BackgroundAtrial fibrillation (AF) is a very common arrhythmia with significant incidence rate and mortality. Several studies have shown a notable correlation between non-alcoholic fatty liver disease (NAFLD) and AF. It has been observed that serum cholinesterase (SChE) levels are elevated in individuals with fatty liver. However, the relationship between the SChE index and AF is still unclear. Therefore, the purpose of this study is to explore the association between the SChE index and the prevalence of AF in patients with hypertension.MethodWe collected cross-sectional data from January 2018 to April 2021 based on a retrospective study of cardiovascular disease. A total of 748 patients with hypertension were included, of whom 165 had AF. We used logistic regression models to test the relationship between SChE and the prevalence of AF in hypertensive patients.ResultIn hypertensive patients, the SChE index was significantly associated with AF (OR = 0.723, P < 0.001). After adjusting for potential confounding factors, this correlation was still significant (OR = 0.778, P < 0.001). The stability of the model was verified by adjusting the variable type of SChE. The data were further stratified according to whether the patient had fatty liver. In the stratified data, the correlation between SChE and atrial fibrillation was still significant (P < 0.05).ConclusionOur study showed that SChE was significantly negatively correlated with the occurrence of AF in patients with hypertension. And this correlation was not affected by whether the patient had fatty liver.

Serum Cholinesterase, C-reactive Protein, Interleukin 6, and Procalcitonin Levels as Predictors of Mortality in Patients in the Intensive Care Unit.

The prognostic utility of inflammatory markers in survival has been suggested in patients with cancer; however, evidence on their prognostic value in severely ill patients is very limited. We aimed to explore the prognostic value of cholinesterase (ChE), C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) in predicting mortality in patients from the intensive care unit (ICU). Serum levels of ChE, CRP, IL-6 and PCT were measured in ICU patients from December 13th, 2019 to June 28th, 2022. We assessed the predictive power of ChE, CRP, IL-6, and PCT using the receiver operating characteristic (ROC) curves. Furthermore, we evaluated their diagnostic accuracy by comparing the areas under the ROC curve (AUCs) along with their corresponding 95% confidence intervals (CIs). The cut-off values were determined to dichotomise these biomarkers, which were then included in multivariable logistic regression models to examine their relationship with ICU mortality. Among 253 ICU patients included in the study, 66 (26%) died during the ICU stay. The AUCs to predict ICU mortality were 0.643 (95% CI, 0.566-0.719), 0.648 (95% CI, 0.633-0.735), 0.643 (95% CI, 0.563-0.723) and 0.735 (95% CI, 0.664-0.807) for ChE, CRP, IL-6 and PCT, respectively. After adjusting for age, sex and disease severity, lower ChE level (<3.668 × 103 U L-1) and higher levels of CRP (>10.546 mg dL-1), IL-6 (>986.245 pg mL-1) and PCT (>0.505 μg L-1) were associated with higher mortality risk, with odd ratios of 2.70 (95% CI, 1.32-5.54), 4.99 (95% CI, 2.41-10.38), 3.24 (95% CI, 1.54-6.78) and 3.67 (95% CI, 1.45-9.95), respectively. ChE, CRP, IL-6 and PCT were independent ICU mortality risk factors in severely ill patients. Elevated PCT levels exhibited better predictive value than the other three biomarkers that were evaluated.

Decreased cholinesterase level combined with renal dysfunction and sympathetic denervation associated with increased cardiac mortality in systolic heart failure.

Cardiac mortality in patients with heart failure (HF) is likely to be aggravated by malnutrition, assessed by serum cholinesterase (ChE) level, as well as by kidney dysfunction or impairment of cardiac sympathetic denervation. Their prognostic interactions, however, have not been determined. A total of 991 systolic HF patients were enrolled in our HF database following clinical evaluation including evaluation of the nutrition state and assessment of standardized heart-to-mediastinum ratio (sHMR) of iodine-123-labeled meta-iodobenzylguanidine activity. Patients were followed up for an average of 43 months with the primary endpoint of fatal cardiac events (CEs). The CE patient group had a lower level of ChE, lower estimated glomerular filtration rate (eGFR) and lower late sHMR than those in the non-CE patient group. A five-parameter model with the addition of serum ChE selected in the multivariate logistic analysis (model 2) significantly increased the AUC predicting risk of cardiac events compared with a four-parameter model without serum ChE (model 1), and net reclassification analysis also suggested that the model with the addition of serum cholinesterase significantly improved cardiac event prediction. Moreover, in overall multivariate Cox hazard analysis, serum ChE, eGFR and late sHMR were identified to be significant prognostic determinants. HF patients with two or all of the prognostic variables of serum ChE < 230 U/L, eGFR < 48.8 ml/min/1.73 m2 and late sHMR < 1.90 had significantly and incrementally increased CE rates compared to those in HF patients with none or only one of the prognostic variables. Decreases in cholinesterase level and kidney function further increase cardiac mortality risk in HF patients with impairment of cardiac sympathetic innervation.

Predicting outcome in organophosphorus poisoning using RBC cholinesterase and serum cholinesterase values: A hospital-based longitudinal study

Objectives: Organophosphorus (OP) poisoning is a leading cause of mortality due to self-harm in Asian countries, including India. Red blood cell cholinesterase (RBC-ChE) and serum cholinesterase (serum-ChE) levels are used for predicting outcomes. There is a paucity of literature studying the RBC-ChE levels in OP poisoning and comparing it with the serum-ChE levels. Materials and Methods: This is a longitudinal study assessing the outcome in OP poisoning patients using the RBC-ChE and serum-ChE levels. Both enzyme levels are compared and correlated for adult patients presenting within 24 hours of consumption of the OP compound. Sensitivity and specificity are measured. Statistical Analysis: Data were analyzed using SPSS v21. Results of descriptive statistics were expressed as mean T standard deviation (SD) for normally distributed data or median (interquartile range [IQR]) for skewed data for continuous variables and frequency (percentage) for categorical variables. Results: Of the 99 OP poisoning patients included, 20 patients did not survive, and 23 patients required ventilatory support. At admission, RBC-ChE (median, interquartile range [IQR]) was significantly different between survivors (45.2 [30.5–60] U/g Hb) and nonsurvivors (6.3 [4.2–13.4] U/g Hb), while serum-ChE (median, IQR) was not statistically different (p ¼ 0.061) between survivors (350 [247–670]) and nonsurvivors (290 [182–415.8]). Similarly, RBC-ChE was significantly different between patients requiring a ventilator and those not requiring a ventilator (6.8 vs. 44.2 U/g Hb), whereas the serum-ChE values measured on admission were not significantly different for patients requiring a ventilator versus those not requiring a ventilator (290 vs. 348 U/L; p ¼ 0.119). At the cutoff of 20 U/g Hb, RBC-ChE had 90.5% sensitivity and 91% specificity in predicting mortality. Kaplan–Meier survival showed the probability of survival decreased to nearly 50% if the time to reach the hospital was ≤4 hours. Conclusion: RBC-ChE was superior in predicting outcomes in OP poisoning patients compared with serum-ChE measured on the day of admission.