The following is a summary of “Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study,” published in the March 2024 issue of Neurology by Schlake et al.

Researchers started a prospective study to investigate if butyrylcholinesterase (BChE) activity could be a marker for predicting postoperative delirium in patients undergoing cardiac surgery or percutaneous valve replacement.

They enrolled a sum of 237 patients who had received elective cardiothoracic surgery or percutaneous valve replacement at a tertiary care center before their admission. Undergoing preoperative testing with the Montreal Cognitive Assessment to explore cognitive deficits, they were evaluated for postoperative delirium twice daily over three days using either the 3D-CAM or the CAM-ICU, depending on their level of consciousness. BChE activity was assessed at three points before and after the surgery.

The results showed that postoperative delirium affected 39.7% of patients (n = 94). Univariate analysis indicated a link between pre- and postoperative BChE activity and its occurrence (P=0.037, P=0.001). However, there is no association between postoperative delirium and the decline in BChE activity (pre- to postoperative, P=0.327). In multivariable analysis, neither preoperative nor postoperative BChE activity was independently associated with postoperative delirium (P=0.086, P=0.484). Preoperative BChE activity was lower in older patients (B = -12.38, P=0.011) and in those with a history of stroke (B = -516.173, P=0.008) or alcohol abuse (B = -451.47, P=0.034). Lower postoperative BChE activity was independently associated with longer procedures (B = -461.90, P=0.002), use of cardiopulmonary bypass (B = -262.04, P=0.022), the number of administered red cell concentrates (B = -40.99, P=0.003), and older age (B = -9.35, P=0.006).

They concluded no link between BChE and delirium was found, but preoperative levels linked to patient vulnerability and postoperative levels reflected surgery complexity.

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03580-9