Cholinesterase Values Research Articles

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.

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.

Adverse neurobehavioral changes with reduced blood and brain cholinesterase activities in mice treated with statins.

Pleiotropic effects of hypolipidemic statins with behavioral outcomes have been suggested in humans and laboratory animals. There is limited information on the neurobehavioral effects of statins in mice. The aim of the present study was to examine changes in neurobehavioral performance and cholinesterase (ChE) activity in mice after high doses of three commonly used statins (atorvastatin, simvastatin, and rosuvastatin). Two hours after vehicle (control) or statin dosing at 250, 500, 750, or 1000 mg/kg orally, each mouse was subjected to 5 min open-field activity, negative geotaxis at an angle of 45°/60 s, 5 min head pocking, and forced swimming endurance. Plasma, erythrocyte, and brain ChE activities were determined spectrophotometrically 2 and 24 h after oral dosing of statins at 500 and 1000 mg/kg. The statins variably, but dose-dependently and significantly (p < 0.05) delayed the latency to move in the open-field arena, decreased locomotion and rearing, reduced head pocking, and delayed negative geotaxis performance. However, statins significantly increased the duration of forced swimming and decreased the duration of immobility in the swimming tank. Statins significantly and dose-dependently decreased plasma, erythrocyte, and brain ChE activity 2 and 24 h after dosing. Plasma and brain ChE activities recovered by 5%-32.9% and 5.7%-14.4% 24 h later from the 2 h ChE values, respectively. High doses of statins differentially modulate neurobehavioral outcomes in mice in association with reduced plasma, erythrocyte, and brain ChE activity. Plasma or erythrocyte ChE may be used for biomonitoring of the adverse/therapeutic effects of statins.

Plasma Cholinesterase Activity in Patients With Rheumatoid Arthritis and Toxoplasmosis.

Background and objective Rheumatoid arthritis (RA) is a chronic autoimmune disease causing synovium inflammation and functional impairment. Toxoplasmosis is an intracellular zoonotic parasitic infection anda risk factor in immunosuppressed diseases including RA. The involvement of the cholinergic mechanism is not clear when both diseases exist in combination. This study aimed to examine plasma cholinesterase (ChE) activity in patients suffering from RA with concomitant toxoplasmosis, taking into account the enzyme susceptibility to in vitro inhibitory challenge with the organophosphate dichlorvos in RA patients. Methods This was a case-control study involving 88 RA patients and 61 healthy controls of both genders.The RA patients were allocated into three groups. The first group received no therapy (n=14), the second group received conventional anti-arthritis therapy (n=49), and the third group received conventional+biologic therapy(n=25). Plasma ChE activity was determined by an electrometric method. Plasma samples were screened for Toxoplasmagondii (T. gondii)infection, using ELISAT. gondii antibodies IgG andIgM.In vitro inhibition of plasma ChE activitywas assessed by incubating the samples with dichlorvos at0.25 and 0.5 μM.The time-dependent dichlorvos (0.25 μM)-induced plasma ChE inhibition and its kinetics weredetermined. Results The RA patients comprised 76 (86.4%) females and 12 males (13.6%), whereas healthy controls included 22 (36.1%) females and 39 (63.9%) males. The rates of toxoplasmosis IgG positivity in controls and RA patients were 26.2% and 39.8%, respectively. Plasma ChE activity in patients with RA was significantly higher than that in the control group, by 16%. Plasma ChE values of RA patients with conventional therapy and conventional + biologic therapy were higher than that of the control group, by 18% and 27%, respectively. Odds and risk ratios of elevated plasma ChE activity (20%) in RA patients with therapyindicated that high plasma ChE activity among RA patients with therapyis a risk factor. The plasma ChE activity of T. gondii IgG-positive RA patients was not significantly different from that of theIgG-negative ones. Dichlorvos at 0.25 and 0.5 μM significantly inhibited in vitro plasma ChE activity incontrols and RA patients. The rates of plasma ChE inhibition by dichlorvos were lower in the RA groups with conventional therapyin comparison with those in the control group (77% vs. 91%). Examining the dichlorvos time-dependent ChE inhibition kinetics, RA groups showed increases in the half-life of inhibition by 23.6% to 32.7% and the total inhibition time by 23.5% to 32.5%, together with decreases in the inhibition rate constant by 19% to 24.5%, an indication of reduced inhibition rate of plasma ChE activity compared to that of the control group. Conclusions The autoimmune nature of RA and its chronicity might have contributed to the increase in plasma ChE activity among the patients. This increase in enzyme activity could be a risk factor in RA patients undergoing conventional therapy alone or in combination with biologic therapy; however, the clinical significance of such a condition remains obscure at present. The in vitro inhibition of plasma ChE activity in RA patients suggests reduced susceptibility of the enzyme to ChE inhibition by dichlorvos. Toxoplasmosis was not a risk factor when plasma ChE activity was taken into account among RA patients.

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.

Organofosfat Zehirlenmesi Olan Kritik Hastalarda Plazmaferez ve Standart Tedavinin Serum Psödokolinesteraz ve Eritrosit Asetilkolinesteraz Düzeyleri Üzerindeki Etkisinin Standart Tedavi ile Karşılaştırılması: Randomize Kontrollü, Açık Etiketli, Klinik Çalışma

Objective: Organophosphates are the insecticides commonly used worldwide. Inadequate treatment in organophosphates poisoning increases morbidity, and mortality. Purpose of the work was to determine the effect of standard treatment alone versus standard treatment plus plasmapheresis on the levels of serum pseudo-cholinesterase, and erythrocyte acetyl cholinesterase in severe patients with organophosphates poisoning. Material and Method: This research is a prospective study. Patients diagnosed with organophosphates poisoning were included in the work. The patients were divided into two groups as the intervention group, and the standard group. The intervention group, plasmapheresis was performed in addition to the standard treatment. Results: The research was conducted with forty cases. (Intervention group n:21, standard group n:19). Serum pseudo-cholinesterase values were 482.5 u/L at baseline, 3723 u/L after plasmapheresis. Erythrocyte acetyl cholinesterase values were 1.91 u/mL on admission, 2.53 u/mL after plasmapheresis. Erythrocyte acetyl cholinesterase and serum pseudo-cholinesterase values were compared between the two groups daily from the admission of patients to intensive care units during the first 5 days, and on the last day in the intensive care units. There was no statistical difference between two groups (p&amp;gt; 0.05), except for the second day. It was observed that there was a statistically significant difference between the pseudo-cholinesterase values in the second day comparison of both groups (p=0.028). Conclusion: In conclusion, plasmapheresis treatment may contribute positively to pseudo-cholinesterase level. This treatment may have provided additional time for the organophosphates to be eliminated from the body. Although acetyl cholinesterase reactivation is achieved with oxime treatment, the clinical effect of this treatment is not clear.

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.

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.

Predictive value of cholinesterase in patients with heart failure: A new blood biochemical marker of undernutrition

Background and aimsThis study was conducted to verify whether serum cholinesterase (ChE) is useful in predicting prognosis and discriminating undernutrition status compared to existing low-nutrition indices of blood chemical tests in patients with heart failure (HF). Methods and resultsA total of 1617 patients (1204 older patients) with HF who evaluated ChE during hospitalization were recruited for this study. The primary outcome was all-cause death, and multivariate survival analysis was performed. We drew a receiver operating characteristic curve for all-cause death, some undernutrition status, such as low body mass index, thin mid-upper arm circumference, low grip strength, and slow gait speed. The area under the curve was used to compare the predictive ability of ChE with some existing nutritional parameters, such as blood biochemical tests, controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI). After adjusting for 29 variables, higher ChE significantly decreased the risk of all-cause death (per 10 increase, hazard ratio: 0.975, 95% confidence interval: 0.952–0.998), and this trend was maintained for older patients (per 10 increase, hazard ratio: 0.972, 95% confidence interval: 0.947–0.997). ChE was moderately correlated with CONUT and GNRI, but the predictive ability for all-cause death was higher for ChE relative to both scores. ChE tended to have an almost consistently high predictive ability compared with other blood biochemical tests. ConclusionsChE was associated with all-cause death and an almost consistently higher predictive ability for all-cause death and undernutrition status in comparison to existing blood chemical tests and nutritional scores.

Clinical value of cholinesterase in patients treated with radical nephroureterectomy for upper urinary tract carcinoma

PurposeTo evaluate the prognostic value and the clinical impact of preoperative serum cholinesterase (ChoE) levels on decision-making in patients treated with radical nephroureterectomy (RNU) for clinically non-metastatic upper tract urothelial cancer (UTUC).MethodsA retrospective review of an established multi-institutional UTUC database was performed. We evaluated preoperative ChoE as a continuous and dichotomized variable using a visual assessment of the functional form of the association of ChoE with cancer-specific survival (CSS). We used univariable and multivariable Cox regression models to establish its association with recurrence-free survival (RFS), CSS, and overall survival (OS). Discrimination was evaluated using Harrell’s concordance index. Decision curve analysis (DCA) was used to assess the impact on clinical decision-making of preoperative ChoE.ResultsA total of 748 patients were available for analysis. Within a median follow-up of 34 months (IQR 15–64), 191 patients experienced disease recurrence, and 257 died, with 165 dying of UTUC. The optimal ChoE cutoff identified was 5.8 U/l. ChoE as continuous variable was significantly associated with RFS (p < 0.001), OS (p < 0.001), and CSS (p < 0.001) on univariable and multivariable analyses. The concordance index improved by 8%, 4.4%, and 7% for RFS, OS, and CSS, respectively. On DCA, including ChoE did not improve the net benefit of standard prognostic models.ConclusionDespite its independent association with RFS, OS, and CSS, preoperative serum ChoE has no impact on clinical decision-making. In future studies, ChoE should be investigated as part of the tumor microenvironment and assessed as part of predictive and prognostic models, specifically in the setting of immune checkpoint-inhibitor therapy.

Spatial distribution differences of cholinesterase in healthy Chinese under the influence of geographical environmental factors.

The main targets of this were to screen the factors that may influence the distribution of cholinesterase (CHE) reference value in healthy people, and further explored the geographical distribution differences of CHE reference value in China. In this study, we collected the CHE data of 17,601 healthy people from 173 cities in China to analyse the correlation between CHE and 22 geography secondary indexes through spearman regression analysis. Six indexes with significant correlation were extracted, and a ridge regression model was built, and the country's urban CHE reference value of healthy Chinese was predicted. By using the disjunctive kriging method, we obtained the geographical distribution of CHE reference values for healthy people in China. The reference value of CHE for healthy Chinese was significantly correlated with the 6 secondary indexes, namely, latitude (°), altitude (m), annual average temperature (°C), annual average relative humidity (%) and annual precipitation (mm), and topsoil sand gravel percentage (% wt). The geographical distribution of CHE values of healthy Chinese showed a trend of being higher in southeast China and lower in northwest. This study lays a foundation for further research on the mechanism of different influencing factors on the reference value of CHE index. A ridge regression model composed of significant influencing factors has been established to provide the basis for formulating reference criteria for the treatment factors of the liver damage diseases and livercancer using CHE reference values in different regions.

Association of Serum Cholinesterase and Liver Enzymes with Clinical Severity and Outcomes in Organophosphorus Poisoning

Abstract Background: Organophosphorus (OP) compound poisoning is a medico-toxic emergency that results in multiorgan failure. The primary mechanism of action is by inhibition of acetylcholinesterase, leading to disruption in processes of oxidative stress, apoptosis, and microsomal metabolism resulting in liver toxicity. The present study was conducted to explore the prognostic value of serum cholinesterase in predicting severity of organophosphorous compound poisoning and the need for ventilatory support; and to understand the role of aspartate aminotransaminase (AST), alanine aminotransaminase (ALT) and bilirubin in assessing the severity of acute organophosphate poisoning. Methodology: Hospital-based prospective observational study was conducted among OP poisoning cases at a tertiary hospital in Hubli. Clinical examination was done during the initial resuscitation and treatment of patients. Three milliliter of plain blood was collected on admission before administration of atropine and plasma cholinesterase level, and other biochemical parameters were estimated. Results: Sixty-five percent of poisoning cases had &gt;50% of cholinesterase activity with normal grade poisoning. Moderate and severe grade poisonings were present among 3% and 5% of poisoning cases, respectively. Patients with cholinesterase level activity of ≤50% had significantly higher proportions of respiratory failure (77%) and fatal outcomes (33%). Median levels of AST (Q2: 73.2 IU/mL) and ALT were significantly higher (Q2: 22.7 IU/L) among severe grade poisoning (Che: &lt;10%) compared to other grades of poisoning. Conclusion: The assessment of cholinesterase level activity in OP poisoning would be a useful guide to the physician for planning of intensive care, duration of hospital stay, and clinical prognosis. Serum AST and ALT levels can also contribute as supportive biomarkers to assess the severity, chances of respiratory failure, and clinical outcomes of OP poisoning.

Corelations Between the Value of Serum Cholinesterase and Child-Pugh and MELD-NA Scores in Cirrhotic Patients

Abstract A variety of laboratory tests are used in the evaluation of the hepatic patients. Serum cholinesterase is reduced in liver disfunction in contrast with other enzymes. The aim of this study was to assess the value of serum cholinesterase in evaluation of the liver reserve function in cirrhotic patients. A total of 70 patients were divided into 3 groups according to the Child-Pugh Score. Using corelation analysis, the correlation between serum cholinesterase and albumin and serum plasma prothrombin time was analysed. Cirrhotic patients were grouped into A, B and C grades as per Child-Pugh score. The results showed that cholinesterase levels tend to decrease according to the Child-Pugh score. The cholinesterase correlated with the albumin serum levels, value of Child-Pugh score and MELD-Na score and didn’t corelate to INR. In conclusion, correlated with the damage severity of the liver cells cholinesterase may respond to liver reserve function.

Cholinesterase is a Potential Biomarker with High Accuracy for the Nephrotic Syndrome Diagnosis in Minors.

BackgroundSerum Cholinesterase (CHE) levels have been found to be elevated in individuals with nephrotic syndrome (NS); nevertheless, it is unknown whether CHE can serve as a biomarker for NS diagnosis and what its diagnostic relevance is for NS in minors.MethodsIn this study, 138 minors aged 1–17 years with NS were enrolled, including 101 patients with the first episode of NS and 37 patients with relapsing NS. One hundred and four minors suffering from nephritis and 109 healthy minors were included as control groups. The clinical information and laboratory data of all NS patients and the control group were obtained. Logistic regression, correlation analyses and receiver operator characteristic curve were used to examine the value of CHE for NS patients.ResultsCompared to patients diagnosed with nephritis and healthy minors in the control group, the serum CHE levels of total/first episode/relapsing NS patients were substantially higher (P < 0.05). The CHE was an independent risk predictor of total (adjusted odds ratio [OR] = 2.23, 95% confidence interval [CI]: 1.57–3.18)/first episode (adjusted OR = 4.02, 95% CI: 1.47–11.08)/relapsing (adjusted OR = 2.04, 95% CI: 1.42–2.93) NS, and was positively correlated with total cholesterol in total/first episode/relapsing NS patients, respectively. The optimal cutoff for total/first episode/relapsing NS all was 11 KU/L, but the diagnostic accuracy in first episode NS (area under the curve [AUC] = 0.96, 95% CI: 0.94–0.98) was higher than the total NS (AUC = 0.93, 95% CI: 0.91–0.96) and relapsing NS (AUC = 0.85, 95% CI: 0.78–0.92).ConclusionCHE is a possible biomarker for NS and has good diagnostic accuracy for NS in minors, particularly for the first episode of NS in minors.

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.

Correlations between the value of serum cholinesterase and Child-Pugh and Meld-Na scores in cirrhotic patients

To determine the degree of the liver failure in cirrhotic patients we use serum liver function tests In contrast with tests, serum cholinesterase values are low in liver failure. Purpose of the study is to establish if serum cholinesterase corelates with the level of liver disfunction. According to the Child-Pugh Score, 70 patients with chronic liver disease were selected and grouped into 3 categories. Serum cholinesterase, serum albumin and International Normalized Ratio were analyzed and correlations between them were calculated. We observed that the cholinesterase levels tend to decrease according to the Child-Pugh score, lowest in the C group and highest in the A group. The cholinesterase correlated with the albumin serum levels, value of MELD-Na score and Child-Pugh score and did not corelate to INR. In conclusion, serum cholinesterase can be used as an indicator of the liver disfunction grade.

Prognostic value of nutritional parameters in systolic heart failure with renal dysfunction.

Although it is known that assessment and management of the nutritional status of patients are important for treatment of patients with heart failure (HF), there are currently no established indicators. Therefore, we investigated the effects of nutritional parameters as well as conventional parameters on the prognosis of HF patients. A total of 1954 consecutive HF patients with left ventricular ejection fraction (LVEF) less than 50% were enrolled in this study. Transthoracic echocardiography was performed and conventional parameters for HF patients and parameters to assess nutritional status were measured in all patients. Patients were followed up with a primary endpoint of lethal cardiac events (CEs) for 30.2 months. During the follow-up period, cardiac events were documented in 619 HF patients. The CEs group had a lower level of cholinesterase (201.5U/L vs 265.2U/L, P <0.0001), lower estimated GFR (35.2 ml/min/1.73m2 vs 50.3ml/min/1.73m2, P< 0.0001), and lower Geriatric Nutritional Risk Index (GNRI) (91.9 vs 100.0, P< 0.0001) than those in the non-CEs group. Serum cholinesterase, estimated GFR, and GNRI were identified as significant prognostic determinants in multivariate analysis. ROC analyses revealed cut-off values of serum cholinesterase, estimated GFR, and GNRI of 229U/L, 34.2 ml/min/1.73m2, and 95.6, respectively, for identifying high-risk HF patients. HF patients with serum cholinesterase< 229U/L, estimated GFR<34.3 ml/min/1.73m2, and GNRI< 95.6 had a significantly greater rate of CEs than that in the other patients (P<0.0001). Low serum cholinesterase and low GNRI can predict cardiac mortality risk in systolic HF patients with renal dysfunction.

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.

Morbidity Profile and Cholinesterase Levels among Sprayers in Selected Tea Plantations in South India.

Background:The tea plantation industry is composed of a complex chain of workers whose functions often overlap. There has been an extensive use of pesticides in this sector, and in the long term, these can have detrimental effects on the chemical sprayers working in the tea plantations.Aims:To assess the morbidities related to pesticide toxicity and document the most recent plasma cholinesterase levels among the pesticide sprayers working in selected tea plantations in South India.Methods:A cross-sectional study was conducted among 290 chemical sprayers in selected tea plantations in South India after approval from the Institutional Ethics Committee and permission from the plantations. A structured interview schedule was administered by face-to-face interview with the selected sample. The blood cholinesterase detection done at the Estate Hospital was documented by the interviewer.Results:The mean age of the participants was 45.6 ± 8.5 years and all of them were males. About 35.2% of the participants had reported at least one symptom of organophosphorus toxicity. The most common symptom was headache (21.7%) followed by itching of the eyes (20%) and watering of the eyes (16.2%). The blood cholinesterase values were normal in most of the sprayers in the study and only four (1.4%) sprayers had values less than the reference range. There was a significant association between the duration of work, method of spraying, and the blood cholinesterase levels indicating that greater duration of exposure and more direct contact with the chemical raise the cholinesterase levels significantly.Conclusion:The symptoms of pesticide toxicity were reported among the sprayers. The blood cholinesterase levels were normal for most of them.

Ototoxicity of an association of insecticides compounds containing dichlorvos and cypermethrin in Wistar rats

Purpose: to evaluate possible ototoxicity secondary to exposure to a combination of pesticides (dichlorvos and cypermethrin based insecticides). Methods: the Wistar rats were divided into 3 groups (12 animals per group): control (water), positive control for hearing damage (cisplatin) and experimental (exposed to dichlorvos and cypermethrin). The amplitude of distortion product otoacoustic emissions was assessed before and after the exposure. Systemic toxicity signs were also evaluated (clinical signs, weight gain and plasma cholinesterase). Wilcoxon test analyzed the post-exposure amplitudes compared to pre-exposure and Kruskal Wallis following Dunn’s post hoc tests analyzed the amplitudes’ variation. Normally distributed variables were evaluated by Student's t test. Results: body weight and plasma cholinesterase values were similar comparing the pre and post exposure in the experimental group. The control group did not manifest significant amplitude reduction of otoacoustic emissions between the pre and post evaluation. In the group exposed to cisplatin there was a significant reduction in amplitudes at 12 kHz on the right (p = 0.006; Wilcoxon) and 4 kHz on the left (p = 0.032; Wilcoxon). In the group exposed to pesticides, there was a significant reduction in the right ear at 4 kHz (p = 0.034; Wilcoxon) and 8 kHz (p = 0.019; Wilcoxon) and in the left ear at 4 kHz (p = 0.007; Wilcoxon), 6 kHz (p = 0.023; Wilcoxon), 8 kHz (p = 0.045; Wilcoxon) and 12 kHz (p = 0.028; Wilcoxon). Conclusion: there was ototoxicity in the experimental group, without a relevant systemic toxicity.