Hughes_2022_Crit.Care_26_377

Reference

Title : Association between cholinesterase activity and critical illness brain dysfunction - Hughes_2022_Crit.Care_26_377
Author(s) : Hughes CG , Boncyk CS , Fedeles B , Pandharipande PP , Chen W , Patel MB , Brummel NE , Jackson JC , Raman R , Ely EW , Girard TD
Ref : Crit Care , 26 :377 , 2022
Abstract :

BACKGROUND: Delirium is a frequent manifestation of acute brain dysfunction and is associated with cognitive impairment. The hypothesized mechanism of brain dysfunction during critical illness is centered on neuroinflammation, regulated in part by the cholinergic system. Point-of-care serum cholinesterase enzyme activity measurements serve as a real-time index of cholinergic activity. We hypothesized that cholinesterase activity during critical illness would be associated with delirium in the intensive care unit (ICU) and cognitive impairment after discharge. METHODS: We enrolled adults with respiratory failure and/or shock and measured plasma acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity on days 1, 3, 5, and 7 after enrollment. AChE values were also normalized per gram of hemoglobin (AChE/Hgb). We assessed for coma and delirium twice daily using the Richmond Agitation Sedation Scale and the Confusion Assessment Method for the ICU to evaluate daily mental status (delirium, coma, normal) and days alive without delirium or coma. Cognitive impairment, disability, and health-related quality of life were assessed at up to 6smonths post-discharge. We used multivariable regression to determine whether AChE, AChE/Hgb, and BChE activity were associated with outcomes after adjusting for relevant covariates. RESULTS: We included 272 critically ill patients who were a median (IQR) age 56 (39-67) years and had a median Sequential Organ Failure Assessment score at enrollment of 8 (5-11). Higher daily AChE levels were associated with increased odds of being delirious versus normal mental status on the same day (Odds Ratio [95% Confidence Interval] 1.64 [1.11, 2.43]; P = 0.045). AChE/Hgb and BChE activity levels were not associated with delirious mental status. Lower enrollment BChE was associated with fewer days alive without delirium or coma (P = 0.048). AChE,sAChE/Hgb,sand BChE levels were not significantly associated with cognitive impairment, disability, or quality of life after discharge. CONCLUSION: Cholinesterase activity during critical illness is associated with delirium but not with outcomes after discharge, findings that may reflect mechanisms of acute brain organ dysfunction. TRIAL REGISTRATION: NCT03098472. Registered 31 March 2017.

PubMedSearch : Hughes_2022_Crit.Care_26_377
PubMedID: 36474266

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Citations formats

Hughes CG, Boncyk CS, Fedeles B, Pandharipande PP, Chen W, Patel MB, Brummel NE, Jackson JC, Raman R, Ely EW, Girard TD (2022)
Association between cholinesterase activity and critical illness brain dysfunction
Crit Care 26 :377

Hughes CG, Boncyk CS, Fedeles B, Pandharipande PP, Chen W, Patel MB, Brummel NE, Jackson JC, Raman R, Ely EW, Girard TD (2022)
Crit Care 26 :377