Effect of cholinesterase and lactic acid on severity and prognosis of sepsis

doi:10.3877/cma.j.issn.1674-6880.2020.05.004

Abstract

Abstract:

Objective

To investigate the value of cholinesterase and lactic acid on the severity and prognosis of sepsis patients.

Methods

From January 2018 to December 2018, 86 patients with sepsis were admitted to the Department of Emergency ICU of the Second Xiangya Hospital of Central South University. According to their disease severity, 86 patients were divided into a sepsis group (n = 62) and a septic shock group (n = 24); then according to their 28-d survival status, 86 patients were divided into a survival group (n = 57) and a death group (n = 29). The age, sex, vital signs, ventilator use, vasoactive drug use, cholinesterase, lactic acid examination, acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure estimation (SOFA) score and 28-d prognosis of all patients were recorded. A multivariate Logistic regression was used to analyze risk factors affecting the severity and prognosis of sepsis patients. A receiver operating characteristic (ROC) curve was drawn to analyze the value of cholinesterase and lactic acid in evaluating their severity and prognosis.

Results

The level of cholinesterase [3 897.30 (2 970.70, 4 760.15) U/L vs. 2 718.05 (2 080.25, 3 182.05) U/L] in the sepsis group was significantly higher than that in the septic shock group, while the lactic acid level [2.09 (1.15, 2.99) mmol/L vs. 3.00 (2.10, 7.00) mmol/L], APACHEⅡ score [9.00 (6.00, 15.00) scores vs. 15.50 (9.00, 19.75) scores] and SOFA score [4.00 (2.00, 7.50) scores vs. 9.50 (6.25, 13.75) scores] in the sepsis group were significantly lower (all P < 0.05). The level of cholinesterase [(3 933 ± 1 484) U/L vs. (2 678 ± 756) U/L] in the survival group was significantly higher than that in the death group, while the lactic acid level [2.14 (1.24, 2.98) mmol/L vs. 4.55 (1.72, 12.13) mmol/L], APACHEⅡ score [9.00 (6.00, 14.50) scores vs. 17.50 (15.00, 19.75) scores] and SOFA score [5.00 (2.50, 8.50) scores vs. 10.50 (7.50, 13.75) scores] in the survival group were significantly lower (all P < 0.05). The cholinesterase, lactic acid, APACHEⅡ score and SOFA score were included in the multivariate Logistic regression analysis. The results showed that the cholinesterase was a protective factor for the severity and prognosis of sepsis patients, while the lactic acid, APACHE Ⅱ score and SOFA score were their independent risk factors (all P < 0.05). The ROC curve showed that the cholinesterase, lactic acid, cholinesterase combined with lactic acid, APACHEⅡ score and SOFA score all had predictive value for the severity and prognosis of sepsis patients (all P < 0.05).

Conclusion

Cholinesterase and lactic acid can predict the severity and prognosis of sepsis patients and help clinicians to make accurate and rapid judgment.

Key words: Cholinesterase, Lactic acid, Sepsis, Severity, Prognosis

Juan Jian, Zhibiao He, Jiqiang Liu, Shuangfa Qiu, Xiangping Chai, Hongliang Zhang, Zhenyu Peng. Effect of cholinesterase and lactic acid on severity and prognosis of sepsis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(05): 339-344.

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Figures/Tables 8

References 20

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组别	例数	年龄（岁， ± s）	性别（例，男/女）	胆碱酯酶（U/L）	乳酸（mmol/L）	APACHEⅡ评分（分）	SOFA评分（分）
脓毒症组	62	55 ± 16	35/27	3 897.30（2 970.70，4 760.15）	2.09（1.15，2.99）	9.00（6.00，15.00）	4.00（2.00，7.50）
脓毒性休克组	24	59 ± 19	16/8	2 718.05（2 080.25，3 182.05）	3.00（2.10，7.00）	15.50（9.00，19.75）	9.50（6.25，13.75）
t/H/χ²值		0.763	0.141	3.230	2.690	2.321	3.396
P值		0.453	0.710	0.001	0.007	0.021	0.001

组别	例数	年龄（岁， ± s）	性别（例，男/女）	胆碱酯酶（U/L）	乳酸（mmol/L）	APACHEⅡ评分（分）	SOFA评分（分）
脓毒症组	62	55 ± 16	35/27	3 897.30（2 970.70，4 760.15）	2.09（1.15，2.99）	9.00（6.00，15.00）	4.00（2.00，7.50）
脓毒性休克组	24	59 ± 19	16/8	2 718.05（2 080.25，3 182.05）	3.00（2.10，7.00）	15.50（9.00，19.75）	9.50（6.25，13.75）
t/H/χ²值		0.763	0.141	3.230	2.690	2.321	3.396
P值		0.453	0.710	0.001	0.007	0.021	0.001

组别	例数	年龄（岁， ± s）	性别（例，男/女）	胆碱酯酶（U/L， ± s）	乳酸（mmol/L）	APACHEⅡ评分（分）	SOFA评分（分）
存活组	57	56 ± 16	33/24	3 933 ± 1 484	2.14（1.24，2.98）	9.00（6.00，14.50）	5.00（2.50，8.50）
死亡组	29	57 ± 20	18/11	2 678 ± 756	4.55（1.72，12.13）	17.50（15.00，19.75）	10.50（7.50，13.75）
t/H/χ²值		0.132	0.748	2.819	2.481	3.676	3.062
P值		0.897	0.387	0.007	0.013	< 0.001	0.002

组别	例数	年龄（岁， ± s）	性别（例，男/女）	胆碱酯酶（U/L， ± s）	乳酸（mmol/L）	APACHEⅡ评分（分）	SOFA评分（分）
存活组	57	56 ± 16	33/24	3 933 ± 1 484	2.14（1.24，2.98）	9.00（6.00，14.50）	5.00（2.50，8.50）
死亡组	29	57 ± 20	18/11	2 678 ± 756	4.55（1.72，12.13）	17.50（15.00，19.75）	10.50（7.50，13.75）
t/H/χ²值		0.132	0.748	2.819	2.481	3.676	3.062
P值		0.897	0.387	0.007	0.013	< 0.001	0.002

影响因素	回归系数	标准误	Wald值	P值	OR值	95%CI
胆碱酯酶（U/L）	-0.002	0.010	6.092	0.014	0.998	0.996 ~ 1.000
乳酸（mmol/L）	0.351	0.138	0.432	0.011	1.420	1.083 ~ 1.862
APACHEⅡ评分（分）	0.146	0.084	2.991	0.024	0.864	0.733 ~ 1.020
SOFA评分（分）	0.398	0.138	8.308	0.004	1.489	1.136 ~ 1.953

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