2018, Number 5
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Med Crit 2018; 32 (5)
The levels of acetylcholinesterase in patients with hemodynamic instability discard sepsis as a cause of shock
Monares ZE, Ojeda IEA, Zamora PA, Galindo MC, Cuesta TJC
Language: Spanish
References: 12
Page: 285-289
PDF size: 175.62 Kb.
ABSTRACT
Introduction: Early detection of sepsis is essential to reduce mortality from this condition. So far, no clinical scale or biomarker has been useful in its diagnosis and early detection. Levels of acetylcholinesterase activity have been proposed as a very promising biomarker for the detection of sepsis and septic shock.
Objective: To study the usefulness of acetylcholinesterase levels in the diagnosis of sepsis.
Material and methods: Observational and prospective study in patients of the Intensive Care Unit of the Hospital San Ángel Inn Universidad with diagnosis of hemodynamic instability, classified with or without sepsis, taking acetylcholinesterase levels at admission.
Results: 44 patients were evaluated, 27% with sepsis. The acetylcholinesterase values presented a normal distribution and had diagnostic validity to predict sepsis (AUC: 0.852 95% CI: 0.726-0.977, p ‹ 0.001), with a cut-off value of ‹ 3,956 U/L, sensitivity = 81%, specificity = 75%. The value of neutrophils with a cut ‹ 74% also had a predictive value of sepsis (AUC: 0.710 95% CI: 0.512-0.907, p = 0.034) sensitivity = 75%, specificity = 75%.
Conclusions: In patients with hemodynamic instability with acetylcholinesterase levels greater than 4,000 U/L, sepsis is ruled out as the cause of shock.
REFERENCES
Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006;34(7):1996-2003.
Rosas-Ballina M, Tracey KJ Cholinergic control of inflammation. J Intern Med. 2009;265:663-679.
Berthoud HR, Neuhuber WL. Functional and chemical anatomy of the afferent vagal system. Auton Neurosci. 2000;85:1-17.
Wang H, Yu M, Ochani M, Amella CA, Tanovic M, Susarla S, et al. Nicotinic acetylcholine receptor alpha7 subunit is an essential regulator of inflammation. Nature. 2003;421(6921):384-388.
Bahloul M, Baccouch N, Chtara K, Turki M, Turki O, Ben Hamida C, et al. Value of serum cholinesterase activity in the diagnosis of septic shock due to bacterial infections. J Intensive Care Med. 2016;pii:0885066616636549.
Feng W, Tang C, Guo H, Bao Y, Wen X, Xue T, et al. Prognostic value of serum cholinesterase activities in sepsis patients. Hepatogastroenterology. 2012;60(125):1001-1005.
Oznur Koylu, Mehmet Yortanli. The effect of cholinesterase activity on the diagnosis and prognosis of sepsis. Clinical Medicine Research. 2016;5(3):28-34.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810.
Lawton LD, Roncal S, Leonard E, Stack A, Dinh MM, Byrne CM, et al. The utility of Advanced Trauma Life Support (ATLS) clinical shock grading in assessment of trauma. Emerg Med J. 2014;31(5):384-389.
Levy B, Bastien O, Karim B, Cariou A, Chouihed T, Combes A, et al. Experts’ recommendations for the management of adult patients with cardiogenic shock. Ann Intensive Care. 2015;5(1):52.
Al-Kassab A, Vijayakumar E. Profile of serum cholinesterase in systemic sepsis syndrome (septic shock) in intensive care unit patients. Clinical Chemistry and Laboratory Medicine. 1995;33(1):11-14.
Chiarla C, Giovannini I, Giuliante F, Vellone M, Ardito F, Nuzzo G. Plasma cholinesterase correlations in acute surgical and critical illness. Minerva Chirurgica. 2011;66(4):323-327.