Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial
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 butyrylchol...
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| Format: | Article |
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MDPI AG
2023-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/16/5245 |
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| author | Thomas S. Zajonz Christian Kunzemann Anna Lena Schreiner Frauke Beckert Emmanuel Schneck Andreas Boening Melanie Markmann Michael Sander Christian Koch |
| author_facet | Thomas S. Zajonz Christian Kunzemann Anna Lena Schreiner Frauke Beckert Emmanuel Schneck Andreas Boening Melanie Markmann Michael Sander Christian Koch |
| author_sort | Thomas S. Zajonz |
| collection | DOAJ |
| description | 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 (<i>p =</i> 0.003), had higher EuroSCOREs (<i>p</i> ≤ 0.001), and had longer intensive care unit stays (<i>p</i> < 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 <i>p</i> = 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, <i>p</i> = 0.002). The risk of developing POD was 4.31 times higher with a BChE activity change of ≥32.0% (<i>p</i> = 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. |
| first_indexed | 2024-03-10T23:50:36Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T23:50:36Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8a094a37ac294c3a95e011c884fc01032023-11-19T01:40:14ZengMDPI AGJournal of Clinical Medicine2077-03832023-08-011216524510.3390/jcm12165245Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational TrialThomas S. Zajonz0Christian Kunzemann1Anna Lena Schreiner2Frauke Beckert3Emmanuel Schneck4Andreas Boening5Melanie Markmann6Michael Sander7Christian Koch8Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Cardiac and Vascular Surgery, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyDepartment of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Justus Liebig University of Giessen, 35392 Giessen, GermanyCardiac 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 (<i>p =</i> 0.003), had higher EuroSCOREs (<i>p</i> ≤ 0.001), and had longer intensive care unit stays (<i>p</i> < 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 <i>p</i> = 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, <i>p</i> = 0.002). The risk of developing POD was 4.31 times higher with a BChE activity change of ≥32.0% (<i>p</i> = 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.https://www.mdpi.com/2077-0383/12/16/5245intensive carepostoperative deliriumcardiac surgerypreoperative patient evaluation and improvementcardiopulmonary bypasspostoperative care |
| spellingShingle | Thomas S. Zajonz Christian Kunzemann Anna Lena Schreiner Frauke Beckert Emmanuel Schneck Andreas Boening Melanie Markmann Michael Sander Christian Koch Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial Journal of Clinical Medicine intensive care postoperative delirium cardiac surgery preoperative patient evaluation and improvement cardiopulmonary bypass postoperative care |
| title | Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial |
| title_full | Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial |
| title_fullStr | Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial |
| title_full_unstemmed | Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial |
| title_short | Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial |
| title_sort | potentials of acetylcholinesterase and butyrylcholinesterase alterations in on pump coronary artery bypass surgery in postoperative delirium an observational trial |
| topic | intensive care postoperative delirium cardiac surgery preoperative patient evaluation and improvement cardiopulmonary bypass postoperative care |
| url | https://www.mdpi.com/2077-0383/12/16/5245 |
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