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Zajonz TS, Kunzemann C, Schreiner AL, Beckert F, Schneck E, Boening A, Markmann M, Sander M, Koch C. Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial. J Clin Med 2023; 12:5245. [PMID: 37629287 PMCID: PMC10455192 DOI: 10.3390/jcm12165245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac surgery is regularly associated with postoperative delirium (POD), affected by neuro-inflammation and changes in cholinergic activity. Therefore, this prospective observational study aimed to evaluate whether pre- and perioperative changes in blood acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity were associated with POD development in patients undergoing isolated elective coronary artery bypass graft (CABG) surgery. It included 93 patients. Pre- and postoperative blood AChE and BChE activities were measured with photometric rapid-point-of-care-testing. The Intensive Care Delirium Screening Checklist and the Confusion Assessment Method for the Intensive Care Unit were used to screen patients for POD. POD developed in 20 patients (21.5%), who were older (p = 0.003), had higher EuroSCOREs (p ≤ 0.001), and had longer intensive care unit stays (p < 0.001). On postoperative day one, BChE activity decreased from preoperative values more in patients with (31.9%) than without (23.7%) POD (group difference p = 0.002). Applying a cutoff of ≥32.0% for BChE activity changes, receiver operating characteristic analysis demonstrated a moderate prediction capability for POD (area under the curve = 0.72, p = 0.002). The risk of developing POD was 4.31 times higher with a BChE activity change of ≥32.0% (p = 0.010). Monitoring the pre- to postoperative reduction in BChE activity might be a clinically practicable biomarker for detecting patients at risk of developing POD after CABG surgery.
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Affiliation(s)
- Thomas S. Zajonz
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
| | - Christian Kunzemann
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
| | - Anna Lena Schreiner
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
| | - Frauke Beckert
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
| | - Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
| | - Andreas Boening
- Department of Cardiac and Vascular Surgery, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany;
| | - Melanie Markmann
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
| | - Christian Koch
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.K.); (A.L.S.); (F.B.); (E.S.); (M.M.); (M.S.); (C.K.)
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Saha S, Niehaus H. Diagnostic Value of Cholinesterase Activity for the Development of Postoperative Delirium after Cardiac Surgery. Thorac Cardiovasc Surg 2021; 69:702. [PMID: 34433212 DOI: 10.1055/s-0041-1731282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Heidi Niehaus
- Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Hu B, Xue FS, Shao LJZ, Tian T. Diagnostic Value of Cholinesterase Activity for Postoperative Delirium. Thorac Cardiovasc Surg 2021; 69:700-701. [PMID: 34404094 DOI: 10.1055/s-0041-1731281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bin Hu
- Department of Anesthesiology, Capital Medical University, Beijing Friendship Hospital, Beijing, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Capital Medical University, Beijing Friendship Hospital, Beijing, People's Republic of China
| | - Liu-Jia-Zi Shao
- Department of Anesthesiology, Capital Medical University, Beijing Friendship Hospital, Beijing, People's Republic of China
| | - Tian Tian
- Department of Anesthesiology, Capital Medical University, Beijing Friendship Hospital, Beijing, People's Republic of China
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