Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial.
Thomas S ZajonzChristian KunzemannAnna Lena SchreinerFrauke BeckertEmmanuel SchneckAndreas BoeningMelanie MarkmannMichael SanderChristian KochPublished in: Journal of clinical medicine (2023)
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.
Keyphrases
- coronary artery bypass
- patients undergoing
- cardiac surgery
- percutaneous coronary intervention
- end stage renal disease
- intensive care unit
- minimally invasive
- chronic kidney disease
- newly diagnosed
- ejection fraction
- prognostic factors
- randomized controlled trial
- clinical trial
- peritoneal dialysis
- physical activity
- acute coronary syndrome
- coronary artery disease
- study protocol
- high resolution
- acute respiratory distress syndrome
- mass spectrometry
- patient reported outcomes
- coronary artery bypass grafting
- atrial fibrillation
- surgical site infection
- quantum dots
- community dwelling