Prognostic significance of serum cholinesterase in patients with acute decompensated heart failure: a prospective comparative study with other nutritional indices

Predictive values of four nutritional indices for adverse outcomes in patients with hypertension

BACKGROUND

Malnutrition, evaluated by nutritional indices, is reportedly related to a poor prognosis in patients with hypertension. However, clinical evidence on which index is more suitable for predicting a kidney prognosis is limited, and it has not been evaluated in hypertension. The aim of the present study was to investigate and compare the predictive values of four nutritional indices: Geriatric Nutritional Risk Index (GNRI); Prognostic Nutrition Index (PNI); Triglycerides × Total cholesterol × Body weight Index (TCBI); and the controlling nutritional status (CONUT) score.

METHODS

A retrospective, cohort study of 1255 hypertensive patients under care in the Fukushima Cohort Study was conducted. The primary outcome was kidney events, defined as a combination of a 50% decline in eGFR from baseline and renal failure requiring dialysis therapy or kidney transplantation. Kaplan-Meier analyses and multivariate Cox regression analyses were conducted to examine associations between the four nutritional indices and kidney events. The area under the curve (AUC) values of the receiver-operating characteristic curves were also examined to compare the predictive values of these nutritional indices.

RESULTS

Lower GNRI, lower PNI, and higher CONUT score were significantly related to a higher risk of kidney events. GNRI (AUC = 0.729, 95% confidence interval 0.681-0.777) and PNI (AUC = 0.710, 95% confidence interval 0.665-0.756) had significantly higher AUCs for kidney events than the TCBI and CONUT score.

CONCLUSIONS

GNRI and PNI showed greater predictive values for kidney events than other nutritional indices in patients with hypertension.

Development and validation of a multifactorial nomogram to predict 48 month mortality in decompensated heart failure

BACKGROUND AND AIMS

As the incidence of heart failure (HF) increases, the need for practical tools to evaluate the long-term prognosis in these patients remains critical. Our study aimed to develop a 48 month prediction model for all-cause mortality in decompensated HF patients using available clinical indicators.

METHODS

HF patients (n = 503), 60 years or older, were divided into a training cohort (n = 402) and a validation cohort (n = 101). Data on demographics, comorbidities, laboratory results and medications were gathered. Prediction models were developed using the Prognostic Nutritional Index (PNI), cholinesterase (ChE) and a multifactorial nomogram incorporating clinical variables. These models were constructed using the least absolute shrinkage and selection operator algorithm and multivariate logistic regression analysis. The performance of the model was assessed in terms of calibration, discrimination and clinical utility.

RESULTS

The mean age was 77.11 ± 8.85 years, and 216 (42.9%) were female. The multifactorial nomogram included variables of ChE, lymphocyte count, albumin, serum creatinine and N-terminal pro-brain natriuretic peptide (all P < 0.05). In the training cohort, the nomogram's C-index was 0.926 [95% confidence interval (CI) 0.896-0.950], outperforming the PNI indices at 0.883 and ChE at 0.804 (Z-tests, P < 0.05). The C-index in the validation cohort was 0.913 (Z-tests, P < 0.05). Calibration and decision curve analysis confirmed model reliability, indicating a more significant net benefit than PNI and ChE alone.

CONCLUSIONS

Both the ChE- and PNI-based prediction models effectively predict the long-term prognosis in patients over 60 years of age with decompensated HF. The multifactorial nomogram model shows superior performance, improving clinical decision-making and patient outcomes.

The clinical relevance of mild cognitive impairment in acute heart failure: A comparison with cognitive impairment

BACKGROUND

Although mild cognitive impairment (MCI) has received much attention as a precursor of dementia, its prognostic role has not been fully clarified in patients with heart failure (HF).

METHODS AND RESULTS

We studied 274 patients admitted for acute decompensated HF. Cognitive function was evaluated using Mini Mental State Examination (MMSE). According to the previous definition, MMSE of 0-23, 24-27, and 28-30 were classified as CI (n = 132), MCI (n = 81), and normal cognitive function (n = 61). The primary endpoint was cardiac events, defined as the composite of unplanned HF hospitalization and cardiovascular mortality. During a mean follow-up period of 4.9 ± 3.1 years, 145 patients experienced cardiac events. Multivariable logistic regression analysis showed that hypertension (p = 0.043), low cardiac index (p = 0.022), and low serum albumin level (p = 0.041) had a significant association with cognitive abnormalities. Both CI and MCI were significantly associated with cardiac events after Cox multivariable adjustment [CI: p = 0.001, adjusted HR 2.66 (1.48-4.77); MCI: p = 0.025, adjusted HR 1.90 (1.09-3.31), normal cognitive function group: reference]. Patients with MCI had a significantly higher risk of unplanned HF hospitalization [p = 0.033, adjusted HR 1.91 (1.05-3.47)], but not all-cause mortality (p = 0.533) or cardiovascular mortality (p = 0.920), while CI was significantly associated with all-cause mortality (p = 0.025) and cardiovascular mortality (p = 0.036).

CONCLUSION

Even MCI had a significant risk of cardiac events in patients with acute decompensated HF. This risk was mainly derived from unplanned HF hospitalization.

Use of the Serum Level of Cholinesterase as a Prognostic Marker of Nonfatal Clinical Outcomes in Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Introduction

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) contributes to a poor prognosis. Reliable biomarkers to predict adverse outcomes during hospitalization are important.

Aim

To investigate the relationship between the serum cholinesterase (ChE) level and adverse clinical outcomes, including hypoxemia severity, hypercapnia, duration of hospital stay (DoHS), and noninvasive ventilation (NIV) requirement, in patients with AECOPD.

Methods

Patients hospitalized with AECOPD in the Wuhu Hospital of Traditional Chinese Medicine between January 2017 and December 2021 were included.

Results

A total of 429 patients were enrolled. The serum ChE level was significantly lower in patients with hypercapnia, who required NIV during hospitalization and who had a DoHS of >10 days, with an oxygenation index < 300. The ChE level was correlated negatively with the C-reactive protein level and neutrophil-to-lymphocyte ratio and correlated positively with the serum albumin level. Multivariate logistic regression analysis indicated that a serum ChE level of ≤4116 U/L (OR = 2.857, 95% CI = 1.46-5.58, p = 0.002) was associated significantly with NIV requirement.

Conclusions

The serum ChE level was correlated significantly with complicating severe hypoxemia, hypercapnia, prolonged DoHS, and the need for NIV in patients hospitalized with AECOPD. The serum ChE level is a clinically important risk-stratification biomarker in patients hospitalized with AECOPD.

Association of malnutrition with all-cause and cardiovascular mortality in patients with mild to severe chronic kidney disease undergoing coronary angiography: a large multicenter longitudinal study

PURPOSE

Evidence on the prognostic impact of malnutrition was focused on patients with advanced kidney disease. The relationships between malnutrition and all-cause and cardiovascular mortality in patients with different severity of chronic kidney disease (CKD) have not been adequately addressed. We aimed to reveal the prevalence of malnutrition and its prognostic value in patients with different severity of CKD undergoing coronary angiography (CAG).

METHODS

This was a multicenter, longitudinal, and retrospective cohort study of 12,652 patients with non-dialysis dependent CKD (defined as estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) undergoing CAG from five tertiary hospitals between January 2007 and December 2020. The controlling nutritional status (CONUT) score was applied to assess nutritional status. Cox regression models and competing risk Fine and Gray models were used to examine the relationships between malnutrition, all-cause and cardiovascular mortality. Further stratified analysis was performed according to baseline CKD severity (mild, moderate and severe, defined by eGFR < 30, 30-44 and 45-59 ml/min/1.73 m2).

RESULTS

During a median follow-up of 5.5 years (interquartile range: 3.2 to 8.6 years), 3801 patients (30.0%) died, and 2150 (17.0%) definitely died of cardiovascular disease. After controlling for confounders, patients had higher all-cause mortality (mild, moderate, and severe vs. absent: HR 1.27, 95 CI % [1.17-1.39]; HR 1.54, 95 CI % [1.39-1.71]; HR 2.22, 95 CI % [1.78-2.77], respectively; P for trend < 0.001) and cardiovascular mortality (mild, moderate and severe vs. absent: HR 1.35, 95 CI % [1.21-1.52]; HR 1.67, 95 CI % [1.45-1.92]; HR 2.10, 95 CI % [1.55-2.85], respectively; P for trend < 0.001) with the severity of malnutrition. In further stratified analysis, a similar prognostic impact of malnutrition was observed in patients with mild to moderate CKD, while mild malnutrition did not seem to have a consistent effect on severe CKD patients.

CONCLUSION

Malnutrition is common among patients with mild to severe CKD undergoing CAG and is strongly associated with increased risk of all-cause and cardiovascular mortality. Malnutrition seems to have a modestly stronger impact on mortality in patients with mild to moderate CKD. This study was registered at Clinicaltrials.gov as NCT05050877.

Prognostic value of nutritional screening tools in hospitalized patients with decompensated heart failure: A systematic review and meta-analysis

Nutritional risk screening is fundamental to prevent undesirable outcomes in heart failure (HF). Current reviews of nutritional screening tools encompass both hospitalized and outpatient settings, which may not be suitable because of different clinical manifestations. We hypothesize that multidimensional tools would better identify prognosis of decompensated patients because the tools assess more than isolated aspects. This systematic review aims to explore the association of multidimensional nutritional risk screening tools and prognosis in patients hospitalized with decompensated HF. Five databases were searched for studies that assessed nutritional risk through multidimensional screening tools and its association with prognosis in adults hospitalized with decompensated HF. The 95% confidence interval and relative risk were computed using a random-effects model. Inverse variance method was used. Thirty-eight studies were included. Most studies demonstrated higher nutritional risk was significantly associated with worse prognosis. Quantitative analysis identified higher nutritional risk by using the Mini Nutritional Assessment Short Form (MNA-SF), Controlling Nutritional Status, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to be associated with all-cause mortality. The MNA-SF demonstrated greater magnitude of association with all-cause mortality in older subjects (relative risk, 4.85; 95% confidence interval, 2.0-11.75). Higher nutritional risk was associated with poor prognosis and higher mortality in patients hospitalized with decompensated HF, especially when screened by MNA-SF. Tools were not directly compared. That might reinforce the importance of evaluating multiple aspects when screening hospitalized HF patients once symptoms associated with decompensation frequently mask the underlying nutritional status and risk. PROSPERO registration number (CRD42021256271).

Prognostic Value of Serum Cholinesterase Levels for In-Hospital Mortality among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Cholinesterase (ChE) is associated with the pathogenesis of chronic obstructive pulmonary disease (COPD), including chronic airway inflammation and oxidation/antioxidant imbalance. However, the relationship between serum ChE levels and survival outcomes of patients hospitalized with acute exacerbations of COPD (AECOPD) is unknown. In this retrospective single-center study, we investigated the ability of the serum ChE level to predict in-hospital death in patients hospitalized with AECOPD. The clinicopathological data, including serum ChE levels as well as clinical and biochemical indicators were extracted for 477 patients from the hospital records and analyzed. Our results demonstrated that AECOPD patients with lower serum ChE levels were associated with increased mortality, frequent hospitalization due to acute exacerbations (AE) in the past year, and longer hospital stay. The optimal cutoff value for the serum ChE level was 4323 U/L. The area under the ROC curve (AUC) values for predicting in-hospital mortality based on the serum ChE level was 0.79 (95% confidence interval (CI), 0.72-0.85). Multivariate logistic regression analysis demonstrated that serum ChE level ≤ 4323 U/L (odds ratio (OR) 9.09, 95% CI 3.43-28.3, p < 0.001), age-adjusted Charlson comorbidity index (aCCI), and the number of hospitalizations due to AE in the past year were independent risk factors for predicting the in-hospital mortality of AECOPD patients. In conclusion, our study demonstrated that low serum ChE levels were associated with significantly higher in-hospital mortality rates of patients hospitalized with AECOPD. Therefore, serum ChE level is a promising prognostic predictor of hospitalized AECOPD patients.

Association between serum cholinesterase and the prevalence of atrial fibrillation in Chinese hypertensive population: a cross-sectional study

BACKGROUND

Atrial fibrillation (AF) is a very common arrhythmia with significant incidence rate and mortality. Several studies have shown a notable correlation between non-alcoholic fatty liver disease (NAFLD) and AF. It has been observed that serum cholinesterase (SChE) levels are elevated in individuals with fatty liver. However, the relationship between the SChE index and AF is still unclear. Therefore, the purpose of this study is to explore the association between the SChE index and the prevalence of AF in patients with hypertension.

METHOD

We collected cross-sectional data from January 2018 to April 2021 based on a retrospective study of cardiovascular disease. A total of 748 patients with hypertension were included, of whom 165 had AF. We used logistic regression models to test the relationship between SChE and the prevalence of AF in hypertensive patients.

RESULT

In hypertensive patients, the SChE index was significantly associated with AF (OR = 0.723, P < 0.001). After adjusting for potential confounding factors, this correlation was still significant (OR = 0.778, P < 0.001). The stability of the model was verified by adjusting the variable type of SChE. The data were further stratified according to whether the patient had fatty liver. In the stratified data, the correlation between SChE and atrial fibrillation was still significant (P < 0.05).

CONCLUSION

Our study showed that SChE was significantly negatively correlated with the occurrence of AF in patients with hypertension. And this correlation was not affected by whether the patient had fatty liver.

Predictive value of cholinesterase in patients with heart failure: A new blood biochemical marker of undernutrition

BACKGROUND AND AIMS

This study was conducted to verify whether serum cholinesterase (ChE) is useful in predicting prognosis and discriminating undernutrition status compared to existing low-nutrition indices of blood chemical tests in patients with heart failure (HF).

METHODS AND RESULTS

A total of 1617 patients (1204 older patients) with HF who evaluated ChE during hospitalization were recruited for this study. The primary outcome was all-cause death, and multivariate survival analysis was performed. We drew a receiver operating characteristic curve for all-cause death, some undernutrition status, such as low body mass index, thin mid-upper arm circumference, low grip strength, and slow gait speed. The area under the curve was used to compare the predictive ability of ChE with some existing nutritional parameters, such as blood biochemical tests, controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI). After adjusting for 29 variables, higher ChE significantly decreased the risk of all-cause death (per 10 increase, hazard ratio: 0.975, 95% confidence interval: 0.952-0.998), and this trend was maintained for older patients (per 10 increase, hazard ratio: 0.972, 95% confidence interval: 0.947-0.997). ChE was moderately correlated with CONUT and GNRI, but the predictive ability for all-cause death was higher for ChE relative to both scores. ChE tended to have an almost consistently high predictive ability compared with other blood biochemical tests.

CONCLUSIONS

ChE was associated with all-cause death and an almost consistently higher predictive ability for all-cause death and undernutrition status in comparison to existing blood chemical tests and nutritional scores.

Decreased cholinesterase level combined with renal dysfunction and sympathetic denervation associated with increased cardiac mortality in systolic heart failure

Aims

Cardiac mortality in patients with heart failure (HF) is likely to be aggravated by malnutrition, assessed by serum cholinesterase (ChE) level, as well as by kidney dysfunction or impairment of cardiac sympathetic denervation. Their prognostic interactions, however, have not been determined.

Methods

A total of 991 systolic HF patients were enrolled in our HF database following clinical evaluation including evaluation of the nutrition state and assessment of standardized heart-to-mediastinum ratio (sHMR) of iodine-123-labeled meta-iodobenzylguanidine activity. Patients were followed up for an average of 43 months with the primary endpoint of fatal cardiac events (CEs).

Results

The CE patient group had a lower level of ChE, lower estimated glomerular filtration rate (eGFR) and lower late sHMR than those in the non-CE patient group. A five-parameter model with the addition of serum ChE selected in the multivariate logistic analysis (model 2) significantly increased the AUC predicting risk of cardiac events compared with a four-parameter model without serum ChE (model 1), and net reclassification analysis also suggested that the model with the addition of serum cholinesterase significantly improved cardiac event prediction. Moreover, in overall multivariate Cox hazard analysis, serum ChE, eGFR and late sHMR were identified to be significant prognostic determinants. HF patients with two or all of the prognostic variables of serum ChE < 230 U/L, eGFR < 48.8 ml/min/1.73 m2 and late sHMR < 1.90 had significantly and incrementally increased CE rates compared to those in HF patients with none or only one of the prognostic variables.

Conclusion

Decreases in cholinesterase level and kidney function further increase cardiac mortality risk in HF patients with impairment of cardiac sympathetic innervation.

Potential Cardiologic Protective Effects of Acetylcholinesterase Inhibitors in Patients With Mild to Moderate Dementia

In patients with mild to moderate dementia, acetylcholinesterase inhibitors (AChE-I) are used to improve cognitive functions, but bradycardia, conduction abnormalities, and hypotension are possible side effects because of the peripheral muscarinic M2 receptor stimulation. This study aimed to evaluate the main cardiologic clinical outcomes in patients with dementia who are on AChE-I. In this retrospective, monocentric, observational cohort study, 2 groups were considered: (1) patients with dementia because of the typical and atypical forms of Alzheimer disease treated with AChE-I and (2) cognitively unimpaired, matched control group. The primary end point was a composite of cardiovascular death, nonfatal acute myocardial infarction, myocardial revascularization, occurrence of stroke and/or transient ischemic attacks, and hospitalization for heart failure occurring during a mean of 3.1 years of follow-up. The secondary end points were each individual component of the primary end point, total mortality, noncardiovascular death, and incidence of pacemaker implant. Each group included 221 patients who were homogeneous in terms of age, gender, and main cardiovascular risk factors. Major adverse cardiovascular events occurred in 24 patients with dementia (2.1 per 100 patient-years) compared with 56 in control group (5.0 per 100 patient-years), p = 0.036. Even if not significant, the difference was mainly driven by myocardial revascularization (3.2% vs 6.8%) and hospitalization for heart failure (4.5% vs 14.5%). As expected, noncardiovascular mortality was significantly higher in the treatment group (13.6% vs 2.7% p = 0.006). No significant difference between the groups was observed in terms of other secondary outcomes. In conclusion, in patients with dementia, the use of AChE-I may be protective for cardiovascular outcomes, especially in reducing heart failure hospitalization and myocardial revascularization.

Malnutrition Increases the Risk of Left Ventricular Remodeling

OBJECTIVES

Malnutrition is associated with increased incidence of heart failure (HF). Left ventricular (LV) remodeling is one of the most important processes in the occurrence and evolution of HF. However, the association between nutritional status and LV remodeling is not well known. The study aimed to investigate the association between malnutrition and LV remodeling.

DESIGN

The study was a retrospective observation study.

SETTING AND PARTICIPANTS

We included patients from the registry of Cardiorenal Improvement study from January 2007 to December 2018 at Guangdong Provincial People's Hospital.

MEASUREMENTS

The primary endpoint was LV remodeling, defined as an absolute decrease in LV ejection fraction ≥10% after discharge compared with baseline. Nutritional status was assessed by the Controlling Nutritional Status (CONUT) score. Eligible patients were divided into absent-mild malnutrition group (CONUT score ≤4) and moderate-severe malnutrition group (CONUT score >4). Univariable and multivariable logistic regression was performed to verify the association between malnutrition and left ventricular remodeling.

RESULTS

A total of 7,217 patients (mean age 61.3±10.5 years, 71.7% male) were included in the final analysis, among which 712 (9.9%) had LV remodeling. The incidence of LV remodeling in moderate-severe malnutrition group was significantly higher than that in absent-mild malnutrition group (12.9% vs. 9.5%, p=0.002). In multivariable logistic regression, moderate-severe malnutrition group was significantly associated with 1.69-fold increased risk of LV remodeling after adjusting confounders (OR: 1.69, CI: 1.32-2.16). Similar results were observed in subgroup stratified by age, gender, and coronary artery disease.

CONCLUSION

Nearly one eighth of patients were classified as moderate-severe malnutrition, 12% of whom had LV remodeling. Moderate-severe malnutrition was associated with 69% increased risk of LV remodeling. Further studies are needed to prospectively evaluate the nutrition-oriented managements on outcomes in LV remodeling.

Long-Chain Acylcholines Link Butyrylcholinesterase to Regulation of Non-neuronal Cholinergic Signaling

Acylcholines are comprised of an acyl chain esterified to a choline moiety; acetylcholine is the best-characterized member of this class, functioning as a neurotransmitter in the central and peripheral nervous systems as well as an inhibitor of cytokine production by macrophages and other innate immune cells. Acylcholines are metabolized by a class of cholinesterases, including acetylcholinesterase (a specific regulator of acetylcholine levels) and butyrylcholinesterase (BChE, an enigmatic enzyme whose function has not been resolved by genetic knockout models). BChE provides reserve capacity to hydrolyze acetylcholine, but its importance is arguable given acetylcholinesterase is the most catalytically efficient enzyme characterized to date. While known to be substrates of BChE in vitro, endogenous production of long-chain acylcholines is a recent discovery enabled by untargeted metabolomics. Compared to acetylcholine, long-chain acylcholines show greater stability in circulation with homeostatic levels-dictated by synthesis and clearance-suggested to impact cholinergic receptor sensitivity of acetylcholine with varying levels of antagonism. Acylcholines then provide a link between BChE and non-neuronal acetylcholine signaling, filling a gap in understanding around how imbalances between acylcholines and BChE could modulate inflammatory disease, such as the "cytokine storm" identified in severe COVID-19. Areas for further research, development, and clinical testing are outlined.

The Role of Deep Learning-Based Echocardiography in the Diagnosis and Evaluation of the Effects of Routine Anti-Heart-Failure Western Medicines in Elderly Patients with Acute Left Heart Failure

Objective

The role of deep learning-based echocardiography in the diagnosis and evaluation of the effects of routine anti-heart-failure Western medicines was investigated in elderly patients with acute left heart failure (ALHF).

Methods

A total of 80 elderly patients with ALHF admitted to Affiliated Hangzhou First People's Hospital from August 2017 to February 2019 were selected as the research objects, and they were divided randomly into a control group and an observation group, with 40 cases in each group. Then, a deep convolutional neural network (DCNN) algorithm model was established, and image preprocessing was carried out. The binarized threshold segmentation was used for denoising, and the image was for illumination processing to balance the overall brightness of the image and increase the usable data of the model, so as to reduce the interference of subsequent feature extraction. Finally, the detailed module of deep convolutional layer network algorithm was realized. Besides, the patients from the control group were given routine echocardiography, and the observation group underwent echocardiography based on deep learning algorithm. Moreover, the hospitalization status of patients from the two groups was observed and recorded, including mortality rate, rehospitalization rate, average length of hospitalization, and hospitalization expenses. The diagnostic accuracy of the two examination methods was compared, and the electrocardiogram (ECG) and echocardiographic parameters as well as patients' quality of life were recorded in both groups at the basic state and 5 months after drug treatment.

Results

After comparison, the rehospitalization rate and mortality rate of the observation group were lower than the rates of the control group, but the diagnostic accuracy was higher than that of the control group. However, the difference between the two groups of patients was not statistically marked (P > 0.05). The length and expenses of hospitalization of the observation group were both less than those of the control group. The specificity, sensitivity, and accuracy of the examination methods in the observation group were higher than those of the control group, and the differences were statistically marked (P < 0.05). There was a statistically great difference between the interventricular delay (IVD) of the echocardiographic parameters of patients from the two groups at the basic state and the left ventricular electromechanical delay (LVEMD) parameter values after 5 months of treatment (P < 0.05), but there was no significant difference in the other parameters. After treatment, the quality of life of patients from the two groups was improved, while the observation group was more marked than the control group (P < 0.05).

Conclusion

Echocardiography based on deep learning algorithm had high diagnostic accuracy and could reduce the possibility of cardiovascular events in patients with heart failure, so as to decrease the mortality rate and diagnosis and treatment costs. Moreover, it had an obvious diagnostic effect, which was conducive to the timely detection and treatment of clinical diseases.

Prognostic value of impaired hepato-renal function and liver fibrosis in patients admitted for acute heart failure

AIMS

Cardiohepatic interactions have been a focus of attention in heart failure (HF). The model for end-stage liver disease excluding international normalized ratio (MELD-XI) score has been shown to be useful for predicting poor outcomes in patients with acute decompensated HF (ADHF). Furthermore, the fibrosis-4 (FIB-4) index, a simple marker to assess liver fibrosis, predicts adverse prognoses in patients with HF as well. However, there is little information available on the prognostic significance of the combination of the MELD-XI score and FIB-4 index in patients with ADHF and its association with left ventricular ejection fraction (LVEF) subgroup.

METHODS AND RESULTS

We prospectively studied 466 consecutive patients who were admitted for ADHF [HF with reduced LVEF (LVEF < 40%): n = 164, HF with mid-range LVEF (40% ≤ LVEF < 50%): n = 104, and HF with preserved LVEF (LVEF ≥ 50%): n = 198]. We calculated the MELD-XI score and FIB-4 indices at discharge. The primary endpoint was all-cause death (ACD). During the mean follow-up period of 2.8 years, 143 patients had ACD. In the multivariate Cox analysis, the MELD-XI score and FIB-4 index were independently associated with ACD. Patients were stratified into the following three groups according to the median value of MELD-XI score (=11) and FIB-4 index (=2.13): Group 1 had both a low MELD-XI score and a low FIB-4 index; Group 2 had either a high MELD-XI score (MELD-XI score ≥11) or a high FIB-4 index (FIB-4 index ≥2.13); and Group 3 had both a high MELD-XI score and a high FIB-4 index. Kaplan-Meier analysis revealed that Group 2 and Group 3 had a significantly greater risk of ACD than Group 1 [Group 2 vs. Group 1: adjusted hazard ratio, 2.48 (95% confidence interval: 1.75-3.53), P < 0.0001; Group 3 vs. Group 1: adjusted hazard ratio, 7.03 (95% confidence interval: 3.95-13.7), P < 0.0001]. In addition, the patients with both a higher MELD-XI score and FIB-4 index showed a significantly higher risk of ACD also in the patients with HF with reduced LVEF, HF with mid-range LVEF, and HF with preserved LVEF (all P < 0.0001).

CONCLUSIONS

The combination of MELD-XI score and FIB-4 index may be useful for stratifying patients at risk for ACD in patients with ADHF, irrespective of LVEF.

Incremental prognostic value of cardiac metaiodobenzylguanidine imaging over the co-morbid burden in acute decompensated heart failure

Aims

Co‐morbidities are associated with poor clinical outcomes in patients with chronic heart failure, while cardiac iodine‐123 (I‐123) metaiodobenzylguanidine (MIBG) imaging provides prognostic information in such patients. We sought to prospectively investigate the incremental prognostic value of cardiac MIBG imaging over the co‐morbid burden, in patients admitted for acute decompensated heart failure (ADHF).

Methods and results

In 433 consecutive ADHF patients with survival to discharge, we measured the co‐morbidity using age‐adjusted Charlson co‐morbidity index (ACCI), commonly employed to evaluate a weighted and scored co‐morbid condition, adding additional points for age. In cardiac MIBG imaging, the cardiac MIBG heart‐to‐mediastinum ratio (late HMR) was measured on the delayed image. Over a follow‐up period of 2.9 ± 1.5 years, 160 patients had a cardiac event (a composite of cardiac death and unplanned hospitalization for worsening heart failure). Patients with high ACCI (≥6: median value) had a significantly greater risk of a cardiac event. In multivariate Cox analysis, the ACCI and late HMR were significantly and independently associated with a cardiac event. In both high and low ACCI subgroups (ACCI ≥ 6 and <6, respectively), patients with low late HMR had a significantly greater risk of a cardiac event (high ACCI: 51% vs. 34% P = 0.0026, adjusted HR 1.74 [1.21–2.51]; low ACCI: 34% vs. 17%, P = 0.0228, adjusted HR 2.19 [1.10–4.37]).

Conclusions

Cardiac MIBG imaging could provide additional prognostic information over ACCI, which was also promoted to be a useful risk model, in patients admitted for ADHF.

Admission serum cholinesterase concentration for prediction of in-hospital mortality in very elderly patients with acute ischemic stroke: a retrospective study

BACKGROUND

Cholinesterase as a sensitive biomarker for prognosis in a variety of conditions but it is rare in stroke studies. The very elderly (≥ 80 years of age) represent the most susceptible group of ischemic stroke. We aimed to determine whether admission serum cholinesterase concentration had any effect on clinical outcome in very elderly patients (individuals aged ≥ 80 years) with acute ischemic stroke.

METHODS

A retrospective record review was conducted in two tertiary university hospitals. Elderly patients aged ≥ 80 years admitted with a diagnosis of acute ischemic stroke from January 1, 2014 to November 30, 2019, who had a cholinesterase concentration drawn, were included. The patients were grouped based on the inflection points of the locally weighted regression and smoothing scatterplot (LOESS) curve between cholinesterase levels and in-hospital mortality (study outcome) with lower concentration as reference group.

RESULTS

A total of 612 patients were admitted with a diagnosis of acute ischemic stroke, and 569 met the inclusion criteria. A threshold effect was identified using regression smoothing scatterplot (LOESS), with one cutoff point of 4.0 KU/L. There was a significant difference in-hospital mortality was observed (P < 0.001). After adjusted demographic and clinical features, the OR of cholinesterase for mortality was 0.43 (95% CI 0.34-0.54, P < 0.001), suggesting that lower admission cholinesterase level was an independent risk factors for all-cause mortality among patients with AIS.

CONCLUSIONS

We have demonstrated a significant association between admission cholinesterase concentration and in-hospital mortality in very elderly patients with AIS.

Serum Cholinesterases, a Novel Marker of Clinical Activity in Inflammatory Bowel Disease: A Retrospective Case-Control Study

Background

The aim of our study was to investigate whether serum cholinesterase (ChE) levels were associated with inflammatory bowel disease (IBD).

Materials and Methods

We conducted a retrospective case-control study to clarify the relationship between serum ChE levels and IBD that included 142 patients with ulcerative colitis (UC), 60 patients with Crohn's disease (CD), and 264 healthy controls (HCs). We used ROC curves to evaluate the diagnostic value of serum ChE levels for IBD.

Results

Substantially lower serum ChE levels were detected in patients with UC than in HCs (6376 U/L versus 8418 U/L, P < 0.001) and in patients with CD than in HCs (5181 U/L versus 8418 U/L, P < 0.001). Additionally, patients with CD displayed significantly lower serum ChE levels than patients with UC (5181 U/L versus 6376 U/L, P < 0.01). We also found that there was a negative association between serum ChE levels and the Crohn's Disease Activity Index (CDAI) score of patients with CD (P = 0.011) and the Simple Clinical Colitis Activity Index (SCCAI) score of patients with UC (P = 0.018). The area under the curve (AUC) for serum ChE for the diagnosis of IBD was 0.826, and the AUCs of serum ChE for the diagnosis of CD and UC were 0.890 and 0.800, respectively.

Conclusions

Serum ChE levels have important clinical significance in the diagnosis and assessment of clinical activity in patients with IBD, and the cholinergic anti-inflammatory pathway may provide new ideas for targeted treatment of IBD.

Prognostic Significance of Serum Cholinesterase Level in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction: Insights From the PURSUIT-HFpEF Registry

Background

Malnutrition is one of the most important comorbidities in patients with heart failure with preserved ejection fraction. We recently reported the prognostic significance of serum cholinesterase level and superior predictive power of cholinesterase level to other objective nutritional indices such as the controlling nutritional status score, prognostic nutritional index, and geriatric nutritional risk index in patients with acute decompensated heart failure. The aim of this study was to clarify the prognostic role of cholinesterase in patients with heart failure with preserved ejection fraction/acute decompensated heart failure and investigate incremental cholinesterase value.

Methods and Results

We prospectively studied 274 consecutive patients from the PURSUIT‐HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure With Preserved Ejection Fraction) study. During a follow‐up period of 1.2±0.6 years, 56 patients reached the composite end points (cardiovascular death and readmission for worsening heart failure). In the multivariable Cox analysis, cholinesterase level was significantly associated with the composite end points after adjustment for major confounders. A Kaplan–Meier analysis revealed that patients with low cholinesterase levels (stratified by tertile) had significantly greater risk of reaching the composite end points than those with middle or high cholinesterase levels (P=0.0025). Cholinesterase level showed the best C‐statistics (0.703) for prediction of the composite end points among the objective nutritional indices. C‐statistics of the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for prediction of the composite end points were improved when cholinesterase level was added (C‐statistics, from 0.601 to 0.705; P=0.0408).

Conclusions

Cholinesterase was a useful prognostic marker for prediction of adverse outcome in patients with heart failure with preserved ejection fraction/acute decompensated heart failure.