Point-of-care measured serum cholinesterase activity predicts patient outcome following severe burns. Issue 4 (June 2021)

• Record Type: Journal Article
• Authors: Schmidt, Karsten; Zivkovic, Aleksandar R.; Thiele, Martin; Horter, Johannes; Brenner, Thorsten; Weigand, Markus A.; Kleinschmidt, Stefan; Hofer, Stefan
• Is Part Of: Burns. Volume 47:Issue 4(2021)
• Page Start: 863
• Page End: 872
• Publication Date: 2021-06
• Subjects: ACh acetylcholine -- ABSI abbreviated burn severity index -- ALAT alanine aminotransferase -- ASAT aspartate aminotransferase -- BChE butyrylcholinesterase -- BSA body surface area -- ChE conventionally measured serum cholinesterase -- ER emergency room -- ERA emergency room admission -- GGT gamma-glutamyl transferase -- ICU intensive care unit -- IMC intermediate care unit -- INR international normalized ratio -- IQR interquartile range -- LDH lactate dehydrogenase -- SOFA sequential (sepsis-related) organ failure assessment score -- TISS therapeutic intervention scoring system -- TBSAB total body surface area burn -- RLS resource limited settings -- ROC receiver operator characteristic -- POCT point-of-care testing -- WBCC white blood cell count; Burn injury -- Butyrylcholinesterase -- serum cholinesterase -- Inflammation -- Point of care testing -- Risk stratification; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2020.10.027
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Point of care testing of butyrylcholinesterase in burned patients. Correlation of butyrylcholinesterase activity with burn injury severity. Correlation of butyrylcholinesterase activity with organ dysfunction severity. Correlation of butyrylcholinesterase activity with resource utilization. Butyrylcholinesterase activity predicts outcome of burned patients. Abstract: Risk stratification is of utmost importance in burn therapy. However, suitable bedside biomarkers to evaluate the emerging inflammatory response following burn injuries are missing. Serum cholinesterase (butyrylcholinesterase, BChE) has been shown to be a clinically relevant biomarker in acute inflammatory diseases including burns. In this observational cohort study BChE activity was measured by using point-of-care testing (POCT), a novel method in acute burn care. POCT measurements were performed at emergency room admission (ERA) of 35 patients and repeated 12, 24 and 48 h later. All patients or their legal designees gave informed consent. Patients with burn injuries showed sustained BChE activity reduction following hospital admission. BChE activity correlated negatively with burn injury severity, organ failure severity and intensive care unit resource requirements. BChE activity measured at ERA and 12 h later identified survivors and predicted 28-day patient outcome with noninferior efficacy compared to the abbreviated burn severity index (ABSI) scoring. Finally, POCT-measured BChE activity might complement ABSI scoring and possibly improve early risk stratification in acute burn care therapy.