Serum Cholinesterase Levels Research Articles

Health and agrochemical use experiences of agricultural workers with high serum cholinesterase levels in Northeastern Thailand

In developing countries, agrochemicals are frequently used, resulting in direct and indirect chemical exposure as well as a variety of health concerns. Although agrochemical safety education is essential to promoting protective behavior among agricultural workers, there is a gap in the body of evidence concerning experience with agrochemical use and practice, which is critical for developing and improving educational interventions, so they are more effective and acceptable to the workers' culture and lifestyle. This phenomenology study included twenty agricultural workers with high serum cholinesterase levels in two Thai rural communities. Data from semi-structured interviews were transcribed verbatim and analyzed by using Colaizzi's 7-step data analysis, which is mentioned in the data analysis part. Five themes and three subthemes emerged in relation to agrochemical use and health: (i) long-term chemical exposure; (ii) no need to be concerned about health after chemical exposure; (iii) insufficient chemical protection knowledge and practices; (iv) difficulties in adhering to the agrochemical exposure prevention regimen; and (v) government policy and the growth of the organic products market are important components of chemical use reduction. Based on the findings, the workers lacked awareness regarding protective behaviors, because they did not notice any abnormal changes in their health. We, therefore, recommend that they undergo annual checkups for monitoring their SChE levels, which should be provided by the local government. In addition, agrochemical use is influenced by socioeconomic and political factors. Thus, a health education program for agricultural workers should involve a multidimensional and community-engaged training program that would promote the safe handling of chemicals through contextually appropriate interventions.

Prognostic Value of Serum Cholinesterase Activity in Severe SARS-CoV-2-Infected Patients Requiring Intensive Care Unit Admission.

ABSTRACT.We evaluated the prognostic value of serum cholinesterase (SChE) levels in SARS-CoV-2–infected patients requiring intensive care unit (ICU) admission. This is a retrospective study of severe, critically ill, adult COVID-19 patients, all of whom had a confirmed SARS-CoV-2 infection and were admitted into the ICU of a university hospital. We included all patients admitted to our ICU and whose SChE levels were explored on ICU admission and during ICU stay. One hundred and thirty-seven patients were included. There were 100 male and 37 female patients. The mean of SChE activity on ICU admission was 5,656 ± 1,818 UI/L (range: 1926–11,192 IU/L). The SChE activity on ICU admission was significantly lower in nonsurvivors (P < 0.001). A significant association between the SChE activity on ICU admission and the need for invasive mechanical ventilation was found. We also found a significant correlation between the SChE activity and other biomarkers of sepsis (C-reactive protein, procalcitonin, and leukocytes) on ICU admission and during the ICU stay. A significant correlation among SChE nadir value activity recorded during ICU stay, the occurrence of nosocomial infection, and the outcome of studied patients was found. Our study shows that the low SChE activity value is associated with a severe outcome. It might be used as a biomarker to aid in prognostic risk stratification in SARS-CoV-2–infected patients. Further studies for external validation of our findings are needed on this subject.

Assess Severity of Organophosphate Poisoning by Peradeniya Organophosphorus Poisoning (Pop) Scale

Background: OP compound poisoning is an important indication for emergency admission in most hospitalsthroughout India. WHO estimates that approximately 3 million pesticide poisoning occur worldwide and causingmore than 2,20,000 deaths. Peradeniya Organophosphorus poisoning scale grades the severity of OP poisoningand assess the prognosis of patients. The present study aims to correlate serum cholinesterase level and theclinical criteria score described by the POP scale at initial presentation and the severity of poisoning with need forventilation and outcome.Methods: A hospital based cross sectional observational study was conducted over period from october 2017to october 2019 at tertiary care hospital, Ahmedabad. Total of 75 patients were evaluated for POP scale andserum cholinesterase levels for assessment of severity of poisoning. POP scale was studied to predict the need forventilatory support, duration of hospital stay and outcome.Conclusion: In our study males were most commonly involved (61%). Most commonly affected age group wasbetween 25 to 40 years. 72% had mild, 25.33% had moderate, 2.77% had severe op poisoning according to POPscore. Respiratory failure was more common in moderate and severe op poisoning, 68.42% and 100% respectively.Prolonged icu stay(more than 5 days) was required in moderate and severe group of op posisoning, 63% and 50%respectively as compared to mild group(16.67%). 100% mortality was noted in severe group, 47.36% was noted inmoderate group.

Paralytic Ileus after Prolonged Transient Hypocholinesterasemia Induced by Fenitrothion Poisoning

The patient was a 62-year-old woman who was found in an unconscious. She had paroxysmal atrial fibrillation, dyslipidemia and anxiety neurosis. On arrival, she was in a state of deep coma with hypotension and hypoxia. She underwent tracheal intubation and continuous infusion of noradrenalin. Her serum cholinesterase (butylcholinesterase) level was 2 IU/L. Organophosphate poisoning was suspected. On day three, she regained clear consciousness and accepted that she had intentionally ingested a bottle of fenitrothion with suicidal intent. On the 3rd day, her serum cholinesterase level decreased to 0 U/L, and remained at this level until the 7th day. Prolonged artificial ventilation was required due to weak respiration. On the 14th day, she presented shock, a deterioration of consciousness, a distended abdomen with the peritoneal stimulation sign. She was diagnosed with paralytic ileus with septic shock. Her general condition gradually improved with supportive therapy. At the end of treatment in our hospital, she barely could walk and feed for herself and was transferred to another hospital for rehabilitation. To our knowledge, this is the first reported case of delayed paralytic ileus after prolonged transient hypocholinesterasemia induced by fenitrothion poisoning, in which atropine was not used as treatment. Physicians should pay attention to the complication of paralytic ileus when a patient with organophosphate poisoning shows prolonged hypocholinesterasemia.

Study of serum creatine phosphokinase (CPK) as a prognostic indicator in patients with organophosphorus compound poisoning

Organophosphorus (OP) is an easily accessible pesticide which has a high morbidity and mortality on human exposure. Serum cholinesterase (SChE) is usually used for assessing the severity of poisoning, in this study we assess the role of serum creatine phosphokinase (CPK) as an alternative prognostic marker. This was a single centred, hospital-based, prospective and observational study, conducted on 88 patients with a history of OP compound consumption who were admitted to the ICU of tertiary care hospital, from the time period October 2019 to March 2021. The patients were clinically categorized into mild, moderate and severe categories according to Peradeniya Organophosphorus Poisoning (POP) scale and before initiation of treatment, the samples were sent for estimation of SChE and serum CPK. Out of the 88 patients, OP poisoning was more common in the age group of 21-30 years and males had a higher incidence. Chlorpyriphos (62.5%) was the most common compound. A higher POP score, marked reduction in SChE levels, and increased serum CPK levels were observed to have increased the duration of hospital stay, increased the severity of poisoning, increased the need for ventilator support and also increased the mortality.

Clinical value of serum cholinesterase levels in Nephrotic syndrome: an observational study

BackgroundNephrotic syndrome (NS) results in massive proteinuria and hypoalbuminemia, which are responsible for a compensatory increase in protein synthesis in the liver. Serum cholinesterase (ChE) also increases in NS. However, its clinical value is not fully elucidated.MethodsIn this study, 184 patients with NS who underwent kidney biopsy were included. The patients were divided into two groups according to serum ChE levels, as follows: hypercholinesterasemia (HC) and non-hypercholinesterasemia (NHC) groups. The clinical factors were compared between the two groups.ResultsThe HC group had significantly more severe proteinuria and higher prevalence of high selective proteinuria than the NHC group. Furthermore, the prevalence of minimal change nephrotic syndrome (MCNS) was significantly higher in the HC group than that in the NHC group. Multivariate analysis revealed that the severity of proteinuria and MCNS were significantly associated with HC.ConclusionIn this study, HC in NS was associated with the severity of proteinuria and MCNS, and could help clinicians predict the histological diagnosis of NS.

The impact of low serum cholinesterase levels on survival in patients with colorectal cancer.

Nutritional and inflammatory status have been associated with postoperative recurrence and poor survival in patients with colorectal cancer. The aim of the present study is to investigate the relationship between serum cholinesterase levels and postoperative outcomes among patients who underwent curative resection for colorectal cancer. The study comprised 174 patients who had undergone curative resection for colorectal cancer. We explored the relationship between preoperative serum cholinesterase levels and disease-free survival and overall survival after curative resection. Then patients were divided into the high-cholinesterase group (n = 102) and the low-cholinesterase group (n = 72) to analyze their clinicopathological variables including other nutritional markers and systemic inflammatory responses. In multivariate analysis, lymph node metastasis (P = 0.011) and serum cholinesterase levels (P < 0.01) were independent predictors of disease-free survival, while lymph node metastasis (P = 0.013), serum cholinesterase levels (P < 0.01), and carbohydrate antigen19-9 (P = 0.022) were independent predictors of overall survival. In the low-cholinesterase group, neutrophil to lymphocyte ratio, (P = 0.021), C-reactive protein to albumin ratio (P < 0.01), and distant metastasis (P < 0.01) were higher, and prognostic nutritional index (P < 0.01) was lower compared with the high-cholinesterase group. Preoperative low serum cholinesterase levels can be a prognostic factor for postoperative recurrence and poor prognosis in patients after curative resection for colorectal cancer, suggesting an important role of cholinesterase in the assessment of nutritional and inflammatory status in cancer patients.

Clinical Benefits of Routine Feeding Jejunostomy Tube Placement in Patients Undergoing Esophagectomy

BackgroundRoutine placement of a feeding jejunostomy tube (FJT) following esophagectomy remains controversial due to the risk of complications including small bowel obstruction (SBO). This study aimed to evaluate FJT placement following esophagectomy. MethodsThis retrospective cohort study included consecutive 229 patients undergoing thoracoscopic esophagectomy between January 2010 and June 2020. Short-term outcomes, postoperative nutritional status, incidence of SBO, and long-term outcomes were compared between patients according to FJT placement. ResultsThe total operative duration was significantly longer in the FJT group compared to the no FJT group (P < 0.0001); however, no differences in overall or severe postoperative morbidity were observed. Body weight loss at discharge was significantly attenuated in patients with FJT (5% vs 7%, P = 0.001). Serum cholinesterase levels were significantly higher in patients with FJT (P = 0.002), while no difference was observed in serum albumin levels. At 6-month follow-up, no statistically significant differences were observed in serological markers or percentage body weight. The incidence of SBO was significantly higher in the FJT group (P = 0.006). The 5-year incidence of SBO was 12%. Patients in the FJT group had higher progression-free and overall survival compared to patients in the no FJT group (P = 0.041 and P = 0.033, respectively). A similar trend toward better survival in the FJT group was observed after propensity score matching. ConclusionsRoutine placement of FJT significantly improves postoperative nutritional status and may contribute to improved long-term survival but is associated with increased long-term risk of SBO.

Predictive value of serum cholinesterase in the mortality of acute pancreatitis: A retrospective cohort study.

Severe acute pancreatitis has a high mortality of 20%-40%, but there is a lack of optimal prognostic biomarker for the severity of acute pancreatitis (AP) or mortality. This study is designed to investigate the relationship between serum cholinesterase (ChE) level and poor outcomes of AP. A total of 1904 AP patients were screened in the study, and we finally got 692 patients eligible for analysis. Patients were divided into 2groups based on serum ChE. The primary outcome was mortality, and multivariable logistic regression analysis for mortality was completed. Additionally, we used receiver operating characteristic (ROC) curve analysis to clarify the predictive value of serum ChE for mortality and organ failure. Three hundred and seventy eight patients and 314 patients were included in the ChE-low and ChE-normal group, respectively. Patients in the ChE-low group were older (46.68±12.70 vs. 43.56±12.13years old, p=.001) and had a lower percentage of man (62.4% vs. 71.0%, p=.017) when compared to the ChE-normal group. Mortality was significantly different in two groups (10.3% vs. 0.0%, p<.001). Moreover, organ failure also differed significantly in two groups (46.6% vs. 8.6%, p<.001). Decreased ChE level was independently associated with mortality in acute pancreatitis (odds ratio: 0.440; 95% confidence interval, 0.231, 0.838, p=.013). The area under the curve of serum ChE was 0.875 and 0.803 for mortality and organ failure, respectively. Lower level of serum ChE was independently associated with the severity and mortality of AP.

Prognostic significance of serum cholinesterase in acute myocardial infarction

Background: Autonomic dysfunction has a prognostic significance in various cardiovascular (CV) disorders, particularly atherosclerotic coronary artery disease (CAD). Previous studies are few, regarding the association of parasympathetic dysfunction with increased complications in patients with the acute coronary syndrome, a subset of CAD. We aimed to study the correlation of trends in the serum cholinesterase (sChE) levels, the marker of parasympathetic activity, with the occurrence of major adverse cardiovascular events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients. Methodology: We prospectively observed the levels of sChE in patients with STEMI on the day of admission, day 3, and day 5 along with routine biochemical profile, electrocardiogram, echocardiography, and coronary angiography. The patients were monitored during the hospital stay and were followed up at 1 month for the occurrence of any MACE. The MACE monitored was cardiac death, complete heart block, arrhythmias, and heart failure. The sChE levels are laboratory dependent and a value between 4000 and 14000 IU/L was considered normal in our laboratory. A value <4000 IU/L is noted as a low sChE level. The receiver operating characteristic curve was plotted for the cut off value of the sChE levels to predict the outcomes of patients. Results: Of the 100 STEMI patients studied, the sChE levels were persistently lower in patients who had MACE compared to those without MACE during the hospital stay and at month follow-up, which was statistically significant. A sChE <3745 IU/l on day 5 predicted an increased MACE with a sensitivity of 93.55% and specificity of 92.11%. Conclusion: A persistently low sChE levels from the day of admission can predict MACE in STEMI patients. Larger studies with prolonged follow-up are required for the causal association in the future.

Serum Cholinesterase Levels to Predict All-Cause Mortality in a Community-Based Study: The Takahata Study

Introduction: Serum albumin (Alb) levels have been found to be independent predictors of all-cause mortality in a community-based population, but whether this is the case for serum cholinesterase (ChE) levels is uncertain. This study aimed to determine whether serum ChE levels are independent predictors of all-cause mortality in a community-based population. Methods: A total of 3,504 subjects (mean age 62.5 years) from Takahata, Japan, participated and were followed up for 13.5 years (median 13.2 years). Based on baseline serum Alb and ChE levels, subjects were stratified by interquartile range as low, middle, and high. The correlation between serum Alb and ChE levels was examined by calculating correlation coefficients. The association between each group and all-cause mortality was examined by Kaplan-Meier and Cox proportional hazards analyses. Results: During follow-up, 568 subjects died. There was a positive correlation between serum Alb and ChE levels (r = 0.30). Kaplan-Meier analysis showed that all-cause mortality in the low group was significantly higher for both serum Alb and ChE levels (log-rank p < 0.01). Adjusted Cox proportional hazards analysis showed that the serum Alb level was not an independent predictor of all-cause mortality (hazard ratio [HR] 1.18, 95% confidence interval [CI], 0.95–1.46 for all-cause mortality in the low group compared to the middle group), whereas the serum ChE level was an independent predictor of all-cause mortality (HR 1.30, 95% CI, 1.06–1.59 for all-cause mortality in the low group compared to the middle group). Conclusion: The serum ChE level is an independent predictor of all-cause mortality in the general community-based population.

Mesenchymal stem cell therapy in decompensated liver cirrhosis: a long-term follow-up analysis of the randomized controlled clinical trial

BackgroundMesenchymal stem cell (MSC) infusion was reported to improve liver function in patients with decompensated liver cirrhosis (DLC); however, whether the medication can improve outcome of these patients is poorly understood.MethodsThis prospective, open-labeled, randomized controlled study enrolled 219 patients with HBV-related DLC who were divided into control group (n = 111) and umbilical cord-derived MSC (UC-MSC)-treated group (n = 108), then all of them received a follow-up check from October 2010 to October 2017. The treated patients received three times of UC-MSC infusions at 4-week intervals plus conventional treatment that was only used for control group. The overall survival rate and HCC-free survival rate were calculated as primary endpoints and the liver function and adverse events associated with the medication were also evaluated.ResultsDuring the follow-up check period from 13 to 75th months, there was a significantly higher overall survival rate in the treated group than the control group, while the difference of the hepatocellular carcinoma event-free survival rate between the treated and control groups was not observed during the 75-month follow-up. UC-MSC treatment markedly improved liver function, as indicated by the levels of serum albumin, prothrombin activity, cholinesterase, and total bilirubin during 48 weeks of follow-up. No significant side effects or treatment-related complications were observed in the UC-MSC group.ConclusionsTherapy of UC-MSC is not only well tolerated, but also significantly improves long-term survival rate, as well as the liver function in patients with HBV-related DLC. UC-MSC medication, therefore, might present a novel therapeutic approach for the disease.Graphic abstract

Abstract 10510: Prognostic Value of the Combination of Cardiac MIBG Imaging and Serum Cholinesterase Level in Patients Admitted for Acute Decompensated Heart Failure

Backgrounds: Cardiac MIBG imaging provides prognostic information in patients with acute decompensated heart failure (ADHF). On the other hand, serum cholinesterase (CHE) level, which reflect various factors such as hepatic function, inflammation and nutritional status, has been reported to be associated with poor outcome in ADHF patients. However, there is no information available on the prognostic value of the combination of cardiac MIBG imaging and CHE level in patients admitted for ADHF. Methods: We studied 579 consecutive patients admitted for ADHF. Cardiac MIBG imaging, echocardiography and venous blood sampling were performed just before discharge. The cardiac MIBG heart-to-mediastinum ratio (late HMR) was measured on the chest anterior view images obtained at 200 min after the isotope injection. The primary endpoint was cardiac event (CE) defined as unplanned heart failure hospitalization and cardiac death. Results: During a follow up period of 2.8±0.9 years, 196 patients reached the primary endpoint. On multivariate Cox analysis, late-HMR (p&lt;0.0001, HR 1.82 [1.34-2.47) and serum CHE level (p=0.047, HR 1.40 [1.01-1.94]) were significantly associated with CE after adjustment for age, sex, left ventricular ejection fraction, history of hypertension, diabetes mellitus, hemoglobin, blood urea nitrogen and albumin. Kaplan-Meier survival curve analysis demonstrated that patients with both low serum CHE level (&lt;217 U/L=median value) and late-HMR (&lt;1.66=median value) had a significantly increased risk of CE in than those either or none of them. Conclusion: The combination of cardiac MIBG imaging and serum CHE level would be useful for stratifying ADHF patients at risk for cardiac events.

Abstract 11011: Comparison of Prognostic Value of Liver Dysfunction Scores and Serum Cholinesterase Level in Acute Decompensated Heart Failure Patients with Preserved Left Ventricular Ejection Fraction: Insights from Pursuit-hfpef Registry

Background: Cardiohepatic interactions have been a focus of attention in heart failure. Liver dysfunction scores such as Fibrosis-4 (FIB-4) index, albumin-bilirubin (ALBI) and nonalcoholic fatty liver disease (NAFLD) scores have been shown to be useful for predicting poor outcome in patients (pts) with heart failure. On the other hand, malnutrition is one of the most important comorbidities in patients with heart failure with preserved ejection fraction (HFpEF), and serum cholinesterase level (CHE) was reported to be associated with adverse prognosis. We sought to compare the prognostic value of liver dysfunction scores and CHE in HFpEF pts admitted for acute decompensated heart failure (ADHF). Methods and Results: Data were extracted from a prospective multicenter observational study (PURSUIT-HFpEF) in which collaborating hospitals in Osaka recorded clinical, echocardiographic, and outcome data of HFpEF pts with ADHF. We analyzed 737 pts who survived to discharge. CHE, FIB-4 index, ALBI and NAFLD scores were obtained just before the discharge. During a follow-up period of 1.8±1.0 years, 157 pts had all-cause death. At multivariate Cox analysis, CHE (p&lt;0.0001) was independently and significantly associated with all-cause death after adjustment with important baseline clinical and study characteristics, although FIB-4 index, ALBI and NAFLD scores showed the association with all-cause death at univariate analysis. Receiver-operating characteristic curve analysis showed that CHE had the largest area under the curve for the prediction of all-cause death. Kaplan-Meier analysis revealed that the pts with lower CHE (&lt;208 IU/L=median value) had a significantly higher risk of all-cause death than those with higher CHE (31% vs 11%, p&lt;0.0001, adjusted hazard ratio 3.29 [95% CI 2.31 to 4.69]). Conclusion: CHE would be a more useful and simple prognostic marker for the prediction of total mortality than liver dysfunction scores in HFpEF pts with ADHF.

Cholinesterase level is a predictor of systemic inflammatory response syndrome and complications after cardiopulmonary bypass.

To study the changes of serum cholinesterase (S-ChE) levels in patients with systemic inflammatory response syndrome (SIRS) after cardiopulmonary bypass (CPB) and its predictive value for multiple organ dysfunction syndrome (MODS). Forty-two patients with SIRS after CPB were selected as the SIRS group. Another 42 patients who did not develop SIRS after CPB were selected as the control group. The S-ChE levels of patients were compared between the two groups at the time of intensive care unit (ICU) admission and 48 hours after admission to the ICU. The correlation between S-ChE levels and Acute Physiology and Chronic Health EvaluationII (APACHEII) score, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels was compared between the two groups at the time of ICU admission and 48 hours after ICU admission, and receiver operator characteristic (ROC) curve analysis was used to analyze the accuracy of S-ChE level in diagnosing MODS in patients with SIRS after CPB. There was no significant difference in the S-ChE levels among the non-SIRS patients between the time of admission to the ICU and 48 hours later. However, the S-ChE levels in SIRS patients exhibited a decreasing trend from 48 hours after ICU admission compared with those at the time of ICU admission. Meanwhile, the S-ChE levels were obviously lower in SIRS patients than in non-SIRS patients at those two time points. Furthermore, we found that S-ChE levels were negatively correlated with APACHEII scores as well as the levels of TNF-α and IL-6 at ICU admission and 48 hours after ICU admission in SIRS patients. Meanwhile, S-ChE levels were associated with the occurrence of MODS of SIRS patients. Subsequent ROC curve analysis revealed that early S-ChE levels could predict the occurrence of SIRS complicated by MODS after CBP. S-ChE was significantly decreased in patients with SIRS after CPB, and the decrease of S-ChE in the early stage was closely related to the severity of SIRS after CBP and the increase of inflammatory cytokines. Meanwhile, there was a close relationship between S-ChE activity and MODS in the early stage.

RETROSPECTIVE STUDY OF ORGANOPHOSPHORUS POISONING PATIENTS WITH REFERENCE TO CLINICAL PRESENTATION, SERUM CHOLINESTERASE LEVEL AND OUTCOME TO TREATMENT

The present study was conducted to analyze Organophosphorus poisoning patients with respect to serum cholinesterase level and get an idea of its correlation with various other factors to predict clinical course, severity and outcome of treatment. This was a retrospective study of 6 months duration (July 1st – December 31st 2017) conducted in General Medicine and Record &amp; Statistics Department of tertiary care hospital. The study was approved by the Institutional Ethics Committee. All the patients of OP poisoning and patients with clinical features suggestive of OP poisoning, irrespective of age/sex were included in the study. Non-OP poisoning patients, patients with renal failure and with multiple poisoning with other drugs such as opioids, diazepam, barbiturate, etc were excluded. Out of 262 poisoning cases in this study, 46 cases were OP poisoning. Sex ratio (M:F) is 3.6:1 and 16-30 yrs age group was most commonly affected, unmarried and belonging to rural area. Suicidal being the most common manner of OP poisoning and by oral route. Family stress in case of suicidal poisoning and alcohol influence for accidental poisoning emerged to be the most common reasons. The mean SCE level is 4491 ± 4128 U/L. Most cases were found to be in the range of 1000-2000U/L (32.6%). Mortality rate in this study was only 13%, due to the close proximity of medical facilities available in our region. Vomiting was found to be the most common clinical feature, followed by giddiness and miosis. Hospital stay duration was seen to be more in patients with low level of SCE (&lt; 2000 U/L). Duration of ventilation needed was more among the patients with low level of SCE (&lt; 2000 U/L). But, SCE level did not show any correlation with treatments outcome, blood pressure, respiratory rate, breathlessness, vomiting and unconsciousness. Treatments outcome worsened with increase in gap between OP consumption and hospital admission.

Prepregnancy Assessment of Liver Function to Predict Perinatal and Postpregnancy Outcomes in Biliary Atresia Patients with Native Liver.

Considering that some biliary atresia (BA) survivors with native liver have reached reproductive age and face long-lasting complications, specific attention needs to be paid to pregnant cases. This study aimed to investigate the relationship between liver function, perinatal outcomes, and prognosis. A database review was conducted to identify pregnant BA cases with native liver and perinatal data, and clinical information on BA-related complications was analyzed. Perinatal serum cholinesterase (ChE) levels, model for end-stage liver-disease (MELD) score, and platelet trends were analyzed, and the association between these indicators and perinatal outcomes was investigated. Patients were categorized into three groups according to the perinatal clinical outcomes: favorable (term babies with or without several episodes of cholangitis; n = 3), borderline (term baby and following liver dysfunction; n = 1), and unfavorable (premature delivery with subsequent liver failure; n = 1). Lower serum ChE levels, lower platelet counts, and higher MELD scores were observed in the unfavorable category. Borderline and unfavorable patients displayed a continuous increase in MELD score, with one eventually needing a liver transplantation. Pregnancy in patients with BA requires special attention. Serum ChE levels, platelet counts, and MELD scores are all important markers for predicting perinatal prognosis.

A Study on Correlation Between Serum Cholinesterase Level and Clinical Severity Based on Pop Scale in Organophosphorus Poisoning

Introduction: Organophosphorus (OP) compounds are the most commonly used pesticides worldwide and Organophosphorus poisoning has become the major public health problem especially in developing countries.The case fatality rate following ingestion of Organophosphorus pesticides in developing countries in Asia is 5-20%.Due to limited availability of facilities and resources in Nepal, it is important to prioritize treatment based on severity of poisoning as all patients can’t be managed in Intensive Care Unit.&#x0D; Aims: To study the correlation between serum cholinesterase level and clinical severity based on Peradenya organophosphorus poisoning scale in Organophosphorus poisoning.&#x0D; Methods: The study was conducted in the department of Medicine, Nepalgunj Medical College, Kohalpur, Banke from November 2019 to November 2020. It is based on the descriptive study of 66 patients with Organophosphorus poisoning attending to the emergency department. All patients with history of exposure to Organophosphorus poisoning were included in the study. Peradenya Organophosphorus Poisoning scale was used to assess the clinical severity as mild, moderate and severe. At the same time venous blood samples were collected for serum cholinesterase level.&#x0D; Results: Age group ranged from 16-60 years and majority of patients were in the age group of 20-29 years (34.85%). 53% were females. 74.2% of the patients were from lower socioeconomic status. 83.3% of the patients consumed poison with suicidal intention. Majority of the patients were from tharu ethinicity (40.9%) and were farmers (30.3%). It was observed that there is significant correlation between serum cholinesterase level and severity of poisoning based on Peradenya Organophosphorus Poisoning scale at initial presentation (p value &lt;0.001).&#x0D; Conclusion: There is significant correlation between severity of poisoning and degree of derangement of serum cholinesterase level at the initial presentation. As the facility for the estimation of serum cholinesterase level is not available in all regions of Nepal.

Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning.

This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.

Evaluation of Serum Cholinesterase Level as A diagnostic Marker in Chronic Liver Disease

Background: Liver is the main source of Butyrylcholinesterase (serum cholinesterase). It is a non-specific cholinesterase that is reduced in patients with advanced liver diseases. Measurement of serum Butyrylcholinesterase activity serves as a sensitive indicator of synthetic capacity of the liver. Objective: To evaluate serum cholinesterase levels in chronic liver disease patients. Patients and methods: In this study serum cholinesterase level was evaluated in chronic liver disease patients by a colorimetric kinetic assay method. Thirty cirrhotic subjects and thirty non-cirrhotic hepatic disease subjects were compared to 20 normal individuals. This study was done at Al-Azhar University Hospitals in the period between June 2018 and August 2020. Results: A significant decrease in serum Cholinestrease level was observed in all patients of chronic liver disease as compared to control group. Conclusion: Serum cholinesterase is a better diagnostic and prognostic marker than the conventional liver function test that are raised in other liver disease also.