Clinical Significance Of The Change Of Serum Cholinesterase In The Patients With MODS

Objective To observe the trend of serum ChE change in the patients with MODS, discuss the relationship between the level of the serum ChE and the severity of condition of patients with MODS, also evaluate the value of serum ChE level to judge the prognosis of patients with MODS.Methods All the observeed subjects were selected from the patients admitted to the emergency medical center of Tianjin medical university general hospital from June 2008 to May 2009.92 patients with MODS aged 22-92yr were included while 30 patients without MODS aged 20-87yr were included as control group. The 92 patients with MODS who met MODS criteria according to Marshall standard. Patients who had liver disease, organophosphorus poisoning, active tuberculosis and tumor were excluded. Detect the serum ChE level respectively at admission and in the 24th hour of admission. Calculate the value change of serum ChE. To collect clinical variables of all patients after they were hospitalized within 24 hours, and calculated APACHE II score. The patients with MODS were divided into two groups based on their prognosis:survival group and death group. Statistical analysis was performed by SPSS 16.0 for windows. Based on a single factor analysis to define the risk factors, we performed the multivariate Logistic regression analysis and found independent risk factors which had important effect on clinical. We also used receiver operating characteristic curve analysis in the change value of serum ChE and APACHE II score for prognosis in the patients with MODS.Results Compared with the control group, the MODS group had a decreased level of serum ChE which had a statistic significance (p<0.05). The serum ChE level of the MODS which dead was decreased persistently as comparing with the survival group. Using multivariate Logistic regression analysis, the change value of serum ChE level, APACHE II scores and the number of dysfunction organ are independent risk factors for judging the prognosis in the patients with MODS. The areas under ROC curve for the change value of serum ChE was 0.817±0.050, for the APACHE II score was 0.862±0.039. The sensitivity of the APACHE II score and the change value of serum ChE are 91.2% and 73.5%, while the specificity are 56.9% and 87.9%. Conclusion The serum ChE level at admission,24-hour admission and the change value of the first day have a close relationship with the severity of MODS. And the change value of serum ChE of the first day is an independent risk factor for judging the prognosis in the patients with MODS.