Mueller, Anika and Olbert, Maria and Heymann, Anja and Zahn, Peter K. and Plaschke, Konstanze and von Dossow, Vera and Bitzinger, Diane and Barth, Eberhard and Meister, Markus and Kranke, Peter and Herrmann, Carolin and Wernecke, Klaus-Dieter and Spies, Claudia D. (2019) Relevance of peripheral cholinesterase activity on postoperative delirium in adult surgical patients (CESARO) A prospective observational cohort study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 36 (2). pp. 114-122. ISSN 0265-0215, 1365-2346
Full text not available from this repository. (Request a copy)Abstract
BACKGROUND The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. OBJECTIVES To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital surgical patients, and raise hypotheses on cholinergic regulatory mechanisms in POD. DESIGN A prospective multicentre observational study by the Peripheral Cholinesterase-activity on Neurocognitive Dysfunctions in Surgical Patients (CESARO) study group. SETTING Nine German hospitals. PATIENTS Patients of at least 18 years of age scheduled for inpatient elective surgery for a variety of surgical procedures. A total of 650 patients (mean age 61.5 years, 52.8% male) were included. METHODS Clinical variables, and peripheral AChE and BuChE activities, were assessed throughout the peri-operative period using bedside point-of-care measurements (one pre-operative and two postoperative measurements). POD screening was conducted postoperatively for at least 24 h and up to the third postoperative day using a validated screening tool (nursing delirium screening scale). RESULTS In all, 179 patients (27.5%) developedPODwithin the early postoperative phase. There was a lower BuChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.07, P = 0.091), on postoperative day 1 (Cohen's r = 0.12, P = 0.003) and on postoperative day 2 (Cohen's r = 0.12, P = 0.002). In contrast, there was a significantly higher AChE activity in patients with delirium compared with patients without delirium preoperatively (Cohen's r = 0.10, P = 0.012), on postoperative day 1 (Cohen's r = 0.11, P = 0.004) and on postoperative day 2 (Cohen's r = 0.13, P = 0.002). After adjusting for covariates in multiple logistic regression, a significant association between both BuChE and AChE activities and POD was not found. However, in the multivariable analysis using the Generalized Estimating Equation, cholinesterase activities showed that a decrease of BuChE activity by 100UL(-1) increased the risk of a delirium by approximately 2.1% (95% CI 1.6 to 2.8%) and for each 1Ug(-1) of haemoglobin increase in AChE activity, there was a 1.4% (95% CI 0.6 to 2.2%) increased risk of POD. CONCLUSION Peri-operative peripheral cholinesterase activities may be related to the development of POD, but the clinical implications remain unclear. Further studies, in homogeneous patient groups with a strict protocol for measurement time points, are needed to investigate the relationship between cholinesterase activities and POD.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | SERUM ANTICHOLINERGIC ACTIVITY; HOSPITALIZED-PATIENTS; SYSTEMIC INFECTION; ASSOCIATION; BUTYRYLCHOLINESTERASE; ACETYLCHOLINESTERASE; MANAGEMENT; DEMENTIA; MARKER; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Apr 2020 06:10 |
| Last Modified: | 22 Apr 2020 06:10 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27586 |
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