Schupp_2023_Med.Princ.Pract__

BACKGROUND: Despite improved risk stratification tools and identification of novel biomarkers, sepsis-related mortality has not significantly improved during the past years. OBJECTIVE: This study investigates the diagnostic and prognostic role of the serum albumin and cholinesterase (ChE) in patients with sepsis and septic shock. METHODS: Consecutive patients with sepsis and septic shock from 2019 to 2021 were included. Blood samples were retrieved from day of disease onset (day 1), day 2,3,5 and 7. Firstly, the diagnostic value of the serum albumin for the diagnosis of a septic shock was compared to the ChE. Secondly, the prognostic value of the serum albumin and the ChE for 30-day all-cause mortality was tested. RESULTS: A total of 239 patients were included. With an area under the curve (AUC) of 0.641 to 0.762 on day 3 and 5, the ChE revealed a moderate but better diagnostic discrimination between sepsis and septic shock than the serum albumin. Furthermore, the ChE was able to discriminate between non-survivors and survivors of the 30-day time inter-val (range of AUC 0.612 to 0.686). Patients with a ChE below the median had higher rates of 30-days all-cause mortality in comparison to patients with a ChE above the median (65% vs. 42%, log rank p = 0.001; HR = 1.820; 95% CI 1.273 - 2.601; p = 0.001). CONCLUSION: The ChE reflects a reliable diagnostic and prognostic tool in patients with sepsis and septic shock.