Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study
Abstract Background and objectives Postoperative delirium is a frequent and severe complication after cardiac surgery. Activity of butyrylcholinesterase (BChE) has been discussed controversially regarding a possible role in its development. This study aimed to investigate the relevance of BChE activ...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-024-03580-9 |
| _version_ | 1797274192853336064 |
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| author | Konstantin Schlake Johannes Teller Lukas Hinken Hans Laser Ralf Lichtinghagen Andreas Schäfer Christine Fegbeutel Karin Weissenborn Carolin Jung Hans Worthmann Maria Magdalena Gabriel |
| author_facet | Konstantin Schlake Johannes Teller Lukas Hinken Hans Laser Ralf Lichtinghagen Andreas Schäfer Christine Fegbeutel Karin Weissenborn Carolin Jung Hans Worthmann Maria Magdalena Gabriel |
| author_sort | Konstantin Schlake |
| collection | DOAJ |
| description | Abstract Background and objectives Postoperative delirium is a frequent and severe complication after cardiac surgery. Activity of butyrylcholinesterase (BChE) has been discussed controversially regarding a possible role in its development. This study aimed to investigate the relevance of BChE activity as a biomarker for postoperative delirium after cardiac surgery or percutaneous valve replacement. Methods A total of 237 patients who received elective cardiothoracic surgery or percutaneous valve replacement at a tertiary care centre were admitted preoperatively. These patients were tested with the Montreal Cognitive Assessment investigating cognitive deficits, and assessed for postoperative delirium twice daily for three days via the 3D-CAM or the CAM-ICU, depending on their level of consciousness. BChE activity was measured at three defined time points before and after surgery. Results Postoperative delirium occurred in 39.7% of patients (n = 94). Univariate analysis showed an association of pre- and postoperative BChE activity with its occurrence (p = 0.037, p = 0.001). There was no association of postoperative delirium and the decline in BChE activity (pre- to postoperative, p = 0.327). Multivariable analysis including either preoperative or postoperative BChE activity as well as age, MoCA, type 2 diabetes mellitus, coronary heart disease, type of surgery and intraoperative administration of red-cell concentrates was performed. Neither preoperative nor postoperative BChE activity was independently associated with the occurrence of postoperative delirium (p = 0.086, p = 0.484). Preoperative BChE activity was lower in older patients (B = -12.38 (95% CI: -21.94 to -2.83), p = 0.011), and in those with a history of stroke (B = -516.173 (95% CI: -893.927 to -138.420), p = 0.008) or alcohol abuse (B = -451.47 (95% CI: -868.38 to -34.55), p = 0.034). Lower postoperative BChE activity was independently associated with longer procedures (B = -461.90 (95% CI: -166.34 to -757.46), p = 0.002), use of cardiopulmonary bypass (B = -262.04 (95% CI: -485.68 to -38.39), p = 0.022), the number of administered red cell-concentrates (B = -40.99 (95% CI: -67.86 to -14.12), p = 0.003) and older age (B = -9.35 (95% CI: -16.04 to -2.66), p = 0.006). Conclusion BChE activity is not independently associated with the occurrence of postoperative delirium. Preoperative BChE values are related to patients’ morbidity and vulnerability, while postoperative activities reflect the severity, length and complications of surgery. |
| first_indexed | 2024-03-07T14:55:49Z |
| format | Article |
| id | doaj.art-c76d84e064e44f938ac5b86acc5ad8c8 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-03-07T14:55:49Z |
| publishDate | 2024-03-01 |
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| series | BMC Neurology |
| spelling | doaj.art-c76d84e064e44f938ac5b86acc5ad8c82024-03-05T19:28:25ZengBMCBMC Neurology1471-23772024-03-0124111110.1186/s12883-024-03580-9Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort studyKonstantin Schlake0Johannes Teller1Lukas Hinken2Hans Laser3Ralf Lichtinghagen4Andreas Schäfer5Christine Fegbeutel6Karin Weissenborn7Carolin Jung8Hans Worthmann9Maria Magdalena Gabriel10Department of Neurology, Hannover Medical SchoolDepartment of Neurology, Hannover Medical SchoolDepartment of Anaesthesiology and Intensive Care Medicine, Hannover Medical SchoolDepartment for Educational and Scientific IT Systems, Hannover Medical School, MHH Information TechnologyInstitute of Clinical Chemistry, Hannover Medical SchoolCardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical SchoolDepartment of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical SchoolDepartment of Neurology, Hannover Medical SchoolDepartment of Anaesthesiology and Intensive Care Medicine, Hannover Medical SchoolDepartment of Neurology, Hannover Medical SchoolDepartment of Neurology, Hannover Medical SchoolAbstract Background and objectives Postoperative delirium is a frequent and severe complication after cardiac surgery. Activity of butyrylcholinesterase (BChE) has been discussed controversially regarding a possible role in its development. This study aimed to investigate the relevance of BChE activity as a biomarker for postoperative delirium after cardiac surgery or percutaneous valve replacement. Methods A total of 237 patients who received elective cardiothoracic surgery or percutaneous valve replacement at a tertiary care centre were admitted preoperatively. These patients were tested with the Montreal Cognitive Assessment investigating cognitive deficits, and assessed for postoperative delirium twice daily for three days via the 3D-CAM or the CAM-ICU, depending on their level of consciousness. BChE activity was measured at three defined time points before and after surgery. Results Postoperative delirium occurred in 39.7% of patients (n = 94). Univariate analysis showed an association of pre- and postoperative BChE activity with its occurrence (p = 0.037, p = 0.001). There was no association of postoperative delirium and the decline in BChE activity (pre- to postoperative, p = 0.327). Multivariable analysis including either preoperative or postoperative BChE activity as well as age, MoCA, type 2 diabetes mellitus, coronary heart disease, type of surgery and intraoperative administration of red-cell concentrates was performed. Neither preoperative nor postoperative BChE activity was independently associated with the occurrence of postoperative delirium (p = 0.086, p = 0.484). Preoperative BChE activity was lower in older patients (B = -12.38 (95% CI: -21.94 to -2.83), p = 0.011), and in those with a history of stroke (B = -516.173 (95% CI: -893.927 to -138.420), p = 0.008) or alcohol abuse (B = -451.47 (95% CI: -868.38 to -34.55), p = 0.034). Lower postoperative BChE activity was independently associated with longer procedures (B = -461.90 (95% CI: -166.34 to -757.46), p = 0.002), use of cardiopulmonary bypass (B = -262.04 (95% CI: -485.68 to -38.39), p = 0.022), the number of administered red cell-concentrates (B = -40.99 (95% CI: -67.86 to -14.12), p = 0.003) and older age (B = -9.35 (95% CI: -16.04 to -2.66), p = 0.006). Conclusion BChE activity is not independently associated with the occurrence of postoperative delirium. Preoperative BChE values are related to patients’ morbidity and vulnerability, while postoperative activities reflect the severity, length and complications of surgery.https://doi.org/10.1186/s12883-024-03580-9ButyrylcholinesterasePostoperative deliriumCardiac surgeryPercutaneous valve replacementRisk factors |
| spellingShingle | Konstantin Schlake Johannes Teller Lukas Hinken Hans Laser Ralf Lichtinghagen Andreas Schäfer Christine Fegbeutel Karin Weissenborn Carolin Jung Hans Worthmann Maria Magdalena Gabriel Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study BMC Neurology Butyrylcholinesterase Postoperative delirium Cardiac surgery Percutaneous valve replacement Risk factors |
| title | Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study |
| title_full | Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study |
| title_fullStr | Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study |
| title_full_unstemmed | Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study |
| title_short | Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study |
| title_sort | butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement an observational interdisciplinary cohort study |
| topic | Butyrylcholinesterase Postoperative delirium Cardiac surgery Percutaneous valve replacement Risk factors |
| url | https://doi.org/10.1186/s12883-024-03580-9 |
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