Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients with postoperative delirium

Abstract

BackgroundPatients in intensive care units (ICU) are often diagnosed with postoperative delirium; the duration of which has a relevant negative impact on various clinical outcomes. Recent research found a potentially important role of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) in delirium of critically ill patients on non-surgical ICU or in non-cardiac-surgery patients. We tested the hypothesis that AChE and BChE have an impact on patients after cardiac surgery with postoperative delirium.MethodsAfter obtaining approval from the local ethics committee, this mechanistic study gathered data of all 217 patients included in a randomized controlled trial testing non-pharmacological modifications of care in the cardiac surgical ICU to reduce delirium.Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Nursing Delirium Screening Scale (Nu-DESC) twice a day for the first 3 days after surgery. Further outcome variables were somatic laboratory parameters and variables regarding surgery, anesthesia, and postsurgical recovery. 10 μl venous or arterial blood was drawn and AChE and BChE were determined with ChE check mobile from Securetec.ResultsOf 217 patients, 60 (27.6%) developed postsurgical delirium (POD). Patients with POD were older (p = 0.005), had anemia (p = 0.01), and worse kidney function (p = 0.006). Furthermore, these patients had lower intraoperative cerebral saturation (NIRS) (p < 0.001) and higher intraoperative need of catecholamines (p = 0.03). Delirious patients showed more inflammatory response (p < 0.001). AChE and BChE values were mainly inside the norm. Patients with values outside the norm did not have POD more often than others. Regarding AChE and BChE patients did not differ in having delirium or not (p > 0.10).ConclusionsPostoperative measurement of AChE and BChE did not discern between patients with and without POD. The effect of the cardiac surgical procedure on AChE and BChE remains unclear. Further studies with patients in cardiac surgery are needed to evaluate a possible combination of delirium and the cholinergic transmitter system. There might be possible interactions with AChE/BChE and blood products and the use of cardiopulmonary bypass, which should be investigated more intensively.Trial registrationGerman Clinical Trials Register, DRKS00006217

AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

“…So far, however, there is a lack of evidence that can explain these different courses of AChE-activity in septic patients with associated septic associated encephalopathy. Some studies on delirium and cholinergic transmission in critically ill patients have addressed, among other things, the activity of the butyrylcholinesterase (peripheral cholinesterase activity, BChE-activity) (42)(43)(44). BChE-activity together with AChE-activity in the CNS is responsible for central cholinergic transmitter homeostasis.…”

“…However, unlike AChE-activity, it is not a surrogate for central cholinergic transmission (45). BChE-activity correlates inversely with the C-reactive protein and could be a predictor for the outcome of various diseases (37,44). Overall, BChE-activity appears to re ect the in ammatory level, while AChEactivity may indicate a change in central cholinergic transmission.…”

AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

“…In several investigations addressing delirium in critically ill patients and cholinergic activity a main focus was lying on the Butyrylcholinesterase-activity (peripheral cholinesterase activity, BChE-activity) (45)(46)(47). BChE-activity is part of the central acting cholinesterases, however, it is not a surrogate for the central cholinergic transmission like the AChE-activity (48).…”

“…BChE-activity is part of the central acting cholinesterases, however, it is not a surrogate for the central cholinergic transmission like the AChE-activity (48). BChE-activity inversely correlates with Creactive protein, and could serve a predictor of outcome in different diseases (39,47).…”

Kardioanästhesie: Monitoring und aktuelle hämodynamische Konzepte

“…Komplikationen vom Typ II sind in der Regel nicht mit offensichtlichen persistierenden neurologischen Störungen verbunden, im Hinblick auf das Outcome aber keineswegs trivial (verlängerte Behandlungsdauer, erhöhte Rate allgemeiner Komplikationen, höhere Sterblichkeit im Langzeitverlauf) [8,9]. Pathophysiologisch scheinen neben anamnestischen Faktoren (vorbestehende zerebrale Defizite, eingeschränkte kardiopulmonale Leistungsbreite) und Inflammation insbesondere Störungen der zerebralen Perfusion für die Entwicklung eines Delirs bzw.…”