Can plasma cholinesterase act as an adjuvant prognostic index in acute burn cases?

Abstract

Background:The importance of burn prognostic indices lies not only on the prediction of the outcome of an individual patient, but also on the distribution of the patients in comparable groups of severity for therapeutic purposes. Although the realistic prediction of the outcome of an individual patient is the first and main question of patient family, the quantitative measurement of a patient illness using these indices is of great importance for the burn center in deciding its therapeutic policy. The more accurate the indices, the more useful they are for the latter purpose for these reasons. Since several complications may occur after burn injury, some of them are fatal; the allegation of negligence may not be unusual. The patient relatives may claim that the death is the result of the improper management of the treating medical team rather than the unavoidable complications. Aim: This study aimed to assess the potential role of plasma cholinesterase as an adjuvant prognostic index in acutely burned patients to ascertain malpractice claims. Subjects and methods: A prospective study that was conducted on 40 cases (30 acute burned patients and 10 controls) in The Burn Unit at El Demerdash Hospital. Venous blood samples were collected from all cases under study in 1, 5, and 14 day post burn for measuring plasma cholinesterase, platelets, albumin and CRP. Results: there was significant difference between the control group and the acute burned group regarding the studied parameters except platelets concentration in day one sample. There was negative correlation between plasma cholinesterase, platelets, albumin and TBSA while positive correlation was found with CRP. There was significant difference between the survivors and non survivors regarding all studied parameters in day 1, 5 and 14 except for CRP only in day 5&14 significant difference was noticed. Plasma cholinesterase sensitivity when it was measured alone was 100% in the different study periods, with CRP or albumin or collectively in day 5, 14. Conclusion: The current study concluded that plasma cholinesterase can be measured as a prognostic index alone with 100% sensitivity in day 1, 5 and 14 post burn. When it was measured adjuvant to platelets in day 1 sensitivity was 98%, to CRP or albumin or both in day 5 and 14, the sensitivity was 100%. Recommendations: The present study recommended plasma cholinesterase to be measured as a routine clinical laboratory test for the admitted acutely burned patient.

Diagnostic Value of Cholinesterase Activity for the Development of Postoperative Delirium after Cardiac Surgery

“…Butyrylcholinesterase has been reported to behave as a negative acute phase protein under various circumstances, which by definition is associated with a decrease of at least 25%. 3,4 For the purpose of this study, we chose the 50% cutoff to compensate for the postoperative stress following surgery. As the authors have correctly stated, this study only confirms the associations of postoperative CHE activity of more than 50% and an early postoperative CHE activity below 4,800 U/L with the development of postoperative delirium.…”