Cholinesterase activities and sepsis-associated encephalopathy in viral versus nonviral sepsis

There is evidence that cholinergic imbalance secondary to neuroinflammation plays a role in the pathophysiology of sepsis-associated encephalopathy (SAE). Blood acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities have been proposed as surrogate parameters for the cholinergic function of the central nervous system. Viral sepsis is associated with systemic inflammation and BChE has been reported to be of prognostic value in a small cohort of COVID-19 patients. Nevertheless, the prognostic value of AChE in patients with viral sepsis remains unclear.

We investigated the role of AChE and BChE activities as prognostic biomarkers of SAE and mortality in patients with viral vs nonviral sepsis enrolled in two prospective cohort studies. We quantified the AChE and BChE activities in whole blood of patients at two time points in the acute phase of viral sepsis (N = 108) and compared them with the activities in patients with nonviral sepsis (N = 117) and healthy volunteers (N = 81). Patients were observed until discharge from the intensive care unit (ICU).

Three days after sepsis onset, the median [interquartile range] levels of AChE and BChE were reduced in both patients with viral sepsis (AChE, 5,105 [4,010–6,250] U·L⁻¹; BChE, 1,943 [1,393–2,468] U·L⁻¹) and nonviral sepsis (AChE, 4,424 [3,630–5,055] U·L⁻¹; BChE, 1,095 [834–1,526] U·L⁻¹) compared with healthy volunteers (AChE, 6,693 [5,401–8,020] U·L⁻¹; BChE, 2,645 [2,198–3,478] U·L⁻¹). Patients with viral sepsis with SAE during their ICU stay had lower AChE activity three days after sepsis onset than patients without SAE (4,249 [3,798–5,351] U·L⁻¹ vs 5,544 [4,124–6,461] U·L⁻¹). Butyrylcholinesterase activity seven days after sepsis onset was lower in patients with viral sepsis who died in the ICU than in surviving patients (1,427 [865–2,181] U·L⁻¹ vs 2,122 [1,571–2,787] U·L⁻¹).

Cholinesterase activities may be relevant prognostic markers for the occurrence of SAE and mortality in the ICU in patients with viral sepsis.

This study constitutes an analysis of data from the ongoing studies ICROS (NCT03620409, first submitted 15 May 2018) and ICROVID (DRKS00024162, first submitted 9 February 2021).