Serum cholinesterase as a prognostic factor of mortality in children with sepsis

Introduction: Mortality in septic children continues to be high in Indonesia. Biomarkers for evaluating outcome of children with sepsis are important in deciding further diagnostic examinations or therapies. However, the serum cholinesterase predicting value for mortality in children is still unknown.

Objectives: To evaluate the ability of serum cholinesterase as a prognostic factor for mortality in children with sepsis.

Method: This was a prospective cohort study in the Paediatric Intensive Care Unit (PICU) at Sanglah Hospital, Bali, Indonesia. A total of 78 children aged 28 days to 18 years with sepsis were included and divided into survivor and non-survivor groups. Children with incomplete medical record data, severe protein energy malnutrition, inhibitor cholinesterase therapy, liver dysfunction, HIV infection, malignancy, diabetes mellitus and chronic kidney disease were excluded. Serum cholinesterase level was measured when sepsis was diagnosed. Statistical analysis used Chi-squared test or Mann-Whitney test for bivariate analysis and Poisson regression for multivariate analysis.

Results: Proportion of septic children aged below 5 years was 68.4% in non-survivor group and both groups were predominantly male. Serum cholinesterase <5413.5 U/L was associated with mortality in both bivariate analysis (relative risk 5.33 (2.518-11.297) and multivariate analysis (adjusted relative risk 5.294 (95% CI 2.213-12.662)). However, age <5 years, paediatric logistic organ dysfunction (PELOD) -2 score, and malnutrition were not associated with mortality. 

Conclusions: Serum cholinesterase level was an independent prognostic factor for mortality in children with sepsis.

Sri Lanka Journal of Child Health, 2022; 51(4): 584-590