title: Dynamic changes of serum cholinesterase activity after severe trauma.
abstract: OBJECTIVE
  The aim of the present study was to examine dynamic changes in serum cholinesterase (ChE) activity during early-stage severe trauma and the clinical significance of these changes.
  
  
  METHODS
  This prospective, observational study included 81 patients with severe trauma who were treated between October 2011 and April 2013 in the emergency intensive care unit (EICU) of a university-affiliated, tertiary-care, grade A general hospital in China. Serum ChE activity was measured on Days 1, 3, and 7 post-injury. The correlation of dynamic changes in serum ChE activity with trauma severity and prognosis was assessed. Correlations between changes in serum ChE activity after injury and albumin (ALB), prealbumin (PAB), transferrin (TRF), and C-reactive protein (CRP) levels were also analyzed.
  
  
  RESULTS
  Serum ChE activity in trauma patients was 42.3%-50.2% lower on Days 1, 3, and 7 compared with the control (P<0.001 for all time points), and it continued to decrease after Day 7 in both the survival and death subgroups. In the subgroup with an injury severity score (ISS) of ≤25, serum ChE activity initially decreased, but eventually increased. However, activity decreased continuously in the ISS>25 subgroup. ChE activity was significantly lower in both the death and the ISS>25 subgroups than in the survival and ISS≤25 subgroups on Days 1, 3, and 7 after injury. Activity was negatively correlated with ISS and acute physiology and chronic health evaluation III (APACHE III) at all time points. When comparing the receiver operating characteristic (ROC) curves for predicting prognosis, the area under the curve (AUC) in the plot of serum ChE was similar to the AUCs in plots of ISS and APACHE III, but significantly smaller than the AUC in the plot of the trauma and injury severity score (TRISS). Serum ChE activity was positively correlated with ALB, PAB, and TRF at all time points post-injury. Activity was not significantly correlated with CRP on Day 1, but was significantly and negatively correlated with CRP on Days 3 and 7.
  
  
  CONCLUSIONS
  There is a significant decrease in serum ChE activity after severe trauma. Serum ChE may be regarded as a negative acute phase protein (APP) and the dynamic changes in serum ChE may be useful as an auxiliary indicator for evaluating trauma severity and predicting prognosis.
authors.affiliation: Department of Emergency Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310052, China.
authors.forename: Li
authors.initials: L
authors.lastname: Ba
authors.forename: Ding-qian
authors.initials: DQ
authors.lastname: Wu
authors.forename: An-yu
authors.initials: AY
authors.lastname: Qian
authors.forename: Mao
authors.initials: M
authors.lastname: Zhang
authors.forename: Bing
authors.initials: B
authors.lastname: Xiong
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000378:metabolism; D002681:China; D002802:Cholinesterases / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index; D013997:Time Factors; D014168:Transferrin / Q000378:metabolism; D014947:Wounds and Injuries / Q000097:blood*; D055815:Young Adult
chemical_list: C422455:ALB protein, human; D000209:Acute-Phase Proteins; D000418:Albumins; D012709:Serum Albumin; D014168:Transferrin; D002097:C-Reactive Protein; D002802:Cholinesterases; D000075462:Serum Albumin, Human
keywords: Acute phase protein; Cholinesterase (ChE); Multiple trauma