title: Serum Total Cholinesterase Activity on Admission Is Associated with Disease Severity and Outcome in Patients with Traumatic Brain Injury.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is one of the leading causes of neurological disability. In this retrospective study, serum total cholinesterase (ChE) activities were analyzed in 188 patients for diagnostic as well as predictive values for mortality.
  
  
  RESULTS
  Within 72 hours after injury, serum ChE activities including both acetylcholinesterase and butyrylcholinesterase were measured. Disease severity was evaluated with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score, length of coma, post-traumatic amnesia and injury feature. Neurocognitive and functional scores were assessed using clinical records. Of 188 patients, 146 (77.7%) survived and 42 (22.3%) died within 90 days. Lower ChE activities were noted in the non-survivors vs. survivors (5.94±2.19 vs. 7.04±2.16 kU/L, p=0.023), in septic vs. non-infected patients (5.93±1.89 vs. 7.31±2.45 kU/L, p=0.0005) and in patients with extremely severe injury vs. mild injury (6.3±1.98 vs. 7.57±2.48 kU/L, p=0.049). The trajectories of serum ChE levels were also different between non-survivors and survivors, septic and non-infected patients, mild and severely injured patients, respectively. Admission ChE activities were closely correlated with blood cell counts, neurocognitive and functional scores both on admission and at discharge. Receiver operating characteristic analysis showed that the area under the curve for ChE was inferior to that for either APACHE II or white blood cell (WBC) count. However, at the optimal cutoff value of 5 kU/L, the sensitivity of ChE for correct prediction of 90-day mortality was 65.5% and the specificity was 86.4%. Kaplan-Meier analysis showed that lower ChE activity (<5 kU/L) was more closely correlated with poor survival than higher ChE activity (>5 kU/L) (p=0.04). After adjusting for other variables, ChE was identified as a borderline independent predictor for mortality as analyzed by Binary logistic regression (P=0.078).
  
  
  CONCLUSIONS
  Lowered ChE activity measured on admission appears to be associated with disease severity and outcome for TBI patients.
authors.affiliation: Key Research Laboratory of Tissue Repair and Regeneration of PLA, and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration; First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, 100048, P. R. China.
authors.forename: Qing-Hong
authors.initials: QH
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Hainan Branch of the Chinese PLA General Hospital, Sanya, Hainan, 572013, P. R. China.
authors.forename: An-Min
authors.initials: AM
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, 100048, P. R. China.
authors.forename: Sai-Lin
authors.initials: SL
authors.lastname: He
authors.affiliation: Department of Emergency, First Hospital Affiliated to Wenzhou Medical University, Wenzhou, 325000, P. R. China.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Yao
authors.affiliation: Department of Laboratory Medicine, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, 100048, P. R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, 100048, P. R. China.
authors.forename: Zhi-Wen
authors.initials: ZW
authors.lastname: Zhang
authors.affiliation: Key Research Laboratory of Tissue Repair and Regeneration of PLA, and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration; First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, 100048, P. R. China.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Sheng
authors.affiliation: Key Research Laboratory of Tissue Repair and Regeneration of PLA, and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration; First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, 100048, P. R. China.
authors.forename: Yong-Ming
authors.initials: YM
authors.lastname: Yao
mesh_terms: D018806:APACHE; D000328:Adult; D000647:Amnesia / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001772:Blood Cell Count; D001930:Brain Injuries / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D016022:Case-Control Studies; D002802:Cholinesterases / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D002802:Cholinesterases