ArticleCritical care (London, England)2022
Association between cholinesterase activity and critical illness brain dysfunction.
Article in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03098472 (Cholinesterase Activity and Delirium During Critical Illness Study), which is not on this map. Cited by 24 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cholinesterase Activity and Delirium During Critical Illness Study
Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Effects of music therapy on delirium, clinical outcomes, and psychological and sleep outcomes in adult ICU patients: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- Five-decade prevalence of delirium in pneumonia, risk factors and associated mortality: a systematic review and meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2025Pooled it
- Mechanisms underlying neurocognitive dysfunction following critical illness: a systematic review.Anaesthesia · 2025Pooled it
- Critical care delirium: prevention, identification and management: a narrative review.Anaesthesia · 2026Review
- Current knowledge and challenges of sepsis-associated encephalopathy.Intensive care medicine · 2026Review
- Lower butyrylcholinesterase is associated with postoperative delirium in adult cardiac surgery patients: a secondary analysis of two prospective studies.BMC anesthesiology · 2026Article
- Perfluorooctanoic acid, perfluorobutanoic acid, and undecafluoro-2-methyl-3-oxahexanoic acid disrupt neurotransmitter release and cholinesterase activity.Chemosphere · 2025Article
- Negative Impact of Olanzapine on ICU Delirium Resolution: An Emulated Clinical Trial.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Serum butyrylcholinesterase activity as a predictor of severity and mortality in COVID-19 patients.Scientific reports · 2025Article
- The intersection of delirium and long-term cognition in older adults: the critical role of delirium prevention.Journal of neurology · 2025Review
- Neuroinflammatory Mechanisms of Adult Sepsis-Associated Encephalopathy: Implications for Blood-Brain Barrier Disruption and Oxidative Stress.Diagnostics (Basel, Switzerland) · 2025Review
- Correlation between the neutrophil-to-lymphocyte ratio and the 90-day all-cause mortality in patients with acute respiratory failure: a retrospective analysis based on the MIMIC-IV Database.BMC cardiovascular disorders · 2025Article
- A Critical Reappraisal of Haloperidol for Delirium Management in the Intensive Care Unit: Perspective from Psychiatry.Journal of clinical medicine · 2025Review
- Breaking new ground: machine learning enhances survival forecasts in hypercapnic respiratory failure.Frontiers in medicine · 2025Article
- Integrated in silico identification of cholinesterase inhibitors from Nyctanthes arbor-tristis.PloS one · 2025Article
- Modification in ICU design may influence circadian serum cholinesterase activities: a proof-of-concept pilot study.Intensive care medicine experimental · 2024Article
- Delirium in the ICU: how much do we know? A narrative review.Annals of medicine · 2024Review
- Cholinesterase activities and sepsis-associated encephalopathy in viral versus nonviral sepsis.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Mechanisms underlying delirium in patients with critical illness.Frontiers in aging neuroscience · 2024Review
- Butyrylcholinesterase levels correlate with surgical site infection risk and severity after colorectal surgery: a prospective single-center study.Frontiers in surgery · 2024Article
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelirium is a frequent manifestation of acute brain dysfunction and is associated with cognitive impairment. The hypothesized mechanism of brain dysfunction during critical illness is centered on neuroinflammation, regulated in part by the cholinergic system. Point-of-care serum cholinesterase enzyme activity measurements serve as a real-time index of cholinergic activity. We hypothesized that cholinesterase activity during critical illness would be associated with delirium in the intensive care unit (ICU) and cognitive impairment after discharge.
methodsWe enrolled adults with respiratory failure and/or shock and measured plasma acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity on days 1, 3, 5, and 7 after enrollment. AChE values were also normalized per gram of hemoglobin (AChE/Hgb). We assessed for coma and delirium twice daily using the Richmond Agitation Sedation Scale and the Confusion Assessment Method for the ICU to evaluate daily mental status (delirium, coma, normal) and days alive without delirium or coma. Cognitive impairment, disability, and health-related quality of life were assessed at up to 6 months post-discharge. We used multivariable regression to determine whether AChE, AChE/Hgb, and BChE activity were associated with outcomes after adjusting for relevant covariates.
resultsWe included 272 critically ill patients who were a median (IQR) age 56 (39-67) years and had a median Sequential Organ Failure Assessment score at enrollment of 8 (5-11). Higher daily AChE levels were associated with increased odds of being delirious versus normal mental status on the same day (Odds Ratio [95% Confidence Interval] 1.64 [1.11, 2.43]; P = 0.045). AChE/Hgb and BChE activity levels were not associated with delirious mental status. Lower enrollment BChE was associated with fewer days alive without delirium or coma (P = 0.048). AChE, AChE/Hgb, and BChE levels were not significantly associated with cognitive impairment, disability, or quality of life after discharge.
conclusionCholinesterase activity during critical illness is associated with delirium but not with outcomes after discharge, findings that may reflect mechanisms of acute brain organ dysfunction.
trial registrationNCT03098472. Registered 31 March 2017.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.