Serum Cholinesterase In Patients With Sepsis And Its Clinical Significance

Objective:To observe the changes of serum cholinesterase (ChE) in patients with sepsis, and to investigate the clinical significance to diagnosis and prognosis.Methods:112 patients were studied after admitted to Emergency Center of Tianjin Medical University General Hospital from February 2008～July 2008. We collected clinical variables of all patients after they were hospitalized within 24 hours, and calculated APACHE II score. At the same time, serum ChE was also measured in the first day. Compare the clinical variable difference between the correlational groups. We used SPSS 15.0 and MedCal package for data processing. Based on a single factor logistic regression analysis to define the risk factors, we performed the multinomial logistic regression analysis and found independent risk factors which had important effect on clinical. We also used receiver-operating-characteristic curve (ROC) analysis in the risk factors for prognosis in the patients with sepsis.Results:There was no significant difference in serum ChE between the control group and the reference value.Between the control group and the sepsis one there were significant difference in serum ChE, ALB, TC, ALP, GGT, Ca2+, BMI and APACHE II score. Serum ChE levels in septic patients (3855.38±1276.87U/L) were significantly lower than the control group (7641.78±1885.75U/L), and APACHEII score (18.47±7.49) was significantly higher (14.20±5.03). There was positive correlation between serum ChE and ALB,BMI(r=0.458, p<0.01, r=0.287, p<0.05).We divided the 53 patients with sepsis into≤65-year-old group (37.7%) and >65-year-old group(62.3%). There was significant difference in Serum ChE and APACHE II score between the two groups (p<0.01).There was also significant difference(P<0.05) in serum ChE between the survival group(4026.37±1257.94U/L) and the death one(2731.71±751.53U/L) in patients with sepsis, and APACHEⅡscore in the death group (26.71±7.23) was significantly higher than the survival one(17.22±6.76). There was negative correlation between serum ChE and APACHEⅡscore (r=-0.444, p<0.01). After performing the multinomial logistic regression analysis, we found that serum ChE and APACHEⅡ score are independent risk factors for prognosis in the patients with sepsis. The area under ROC curve for serum ChE was 0.789±0.075, for APACHE II score was 0.840±0.094, between which two there was no statistically significant difference (Z= 0.4241,P>0.05).1. Serum ChE level, which decreases in patients with sepsis, can reflect the severity of sepsis. The lower level of serum ChE, the higher of APACHEⅡscore, and the more severe sepsis.2. Sepsis serum ChE level was shown to be an independent factor predicting the prognosis of patients with sepsis. Low levels of serum ChE is a predictor of poor prognosis in the septic patients.