Grading Evaluation And Prognosis Of Cholinesterase And Apache Ⅱ In ICU Patients

Objective: To analyze the value of serum cholinesterase(SCHE)and acute physiology and chronic health status scoring system II(APACHE II)score in the qualitative and quantitative assessment of the severity of illness and short-term prognosis prediction in critically ill patients,so as to provide some reference for clinicians to quickly identify patients in accordance with.Methods: Using a retrospective research method,a total of 111 patients with comprehensive ICU income and outcomes from the Intensive Care Unit of Baotou Clinical Medical College of Inner Mongolia Medical University from January 2020 to December 2021 were selected,and the baseline characteristics of the patients(general information,The cause of this stay,length of stay),APACHE II score and laboratory observation indicators:cholinesterase(SCHE24),procalcitonin(PCT),albumin(Alb),lactate(Lac),troponin 24 hours after admission(c Tn I),cholinesterase(SCHE72)72 hours after treatment,and the degree of cholinesterase variability(SCHE variability)was calculated.According to the outcome of the 28-day follow-up,the patients were divided into a death group and a survival group.Effective indicators were screened out layer by layer,and correlation analysis was performed to compare the differences with APACHE II.The SCHE72 level ≤2584 U/L was determined as the best critical value for predicting the prognosis of patients,with a sensitivity of 62.5% and a specificity of 90.4%.The differences in mortality,APACHE II score and SCHE variability were compared in this group to further clarify the serum cholesterol level.Predictive value of alkaline esterases.Results: There was no difference in baseline characteristics between the survival and death groups.Compared with the survival group,there was no significant difference in SCHE24 and PCT in the death group,but there were significant differences in APACHE II,SCHE72,SCHE variability,Alb,and Lac(P< 0.05).Layer-by-layer screening and multivariate COX regression analysis showed that with ≥4000U/L as the control standard,SCHE72<4000U/L increased the risk of death by about 2.0times [OR=2.036,95%CI(1.023-4.053),P<0.05],SCHE72<2584U/L increased the risk of death by about 6.0 times [OR=6.015,95%CI(2.865-12.626),P<0.05].The ROC curve was drawn,and the predictive value(area under the curve)of SCHE72,SCHE variability,APACHE II and the combined index of SCHE72 combined with APACHE II for 28-day mortality were 0.762,0.841,0.753,and 0.792,respectively.When the SCHE72 was 2584U/L and the variability was 23.1%,the sensitivity and specificity were the highest.Grouping according to the best cut-off value of SCHE72: group A ≥ 4000 U/L,group B 2584-4000U/L,group C ≤ 2584 U/L,there is no statistical difference in the indicators of group AB among the three groups of ABC.(P>0.05),there were differences in each index in the AC group(P<0.05),only the 28-day mortality was different between the BC groups(P<0.05),and there was no statistical difference in ICU mortality,APACHE II score and SCHE variability difference(P>0.05).Conclusion: APACHE Ⅱ score,SCHE72 and SCHE variability are independent risk factors affecting the short-term prognosis of critically ill patients.The patients whose SCHE minimum reached 2584U/L and/or the variability decreased by more than 23% within 72 hours after admission to the comprehensive ICU indicated the prognosis.not good.SCHE variability has the greatest predictive value for patient prognosis and can identify critically ill patients early.