Prognostic Value of Serum Cholinesterase Levels for In-Hospital Mortality among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Figures & data

Figure 1. The flow chart shows the selection protocol of the study participants.

Figure 2. Distribution of the serum cholinesterase levels in patients with AECOPD. Abbreviations: ChE, cholinesterase; IQR, interquartile range.

Table 1. Baseline characteristics of hospitalized survival and non-survivals groups of AECOPD patients.

Characteristics	Survival	Non-survival	P value
Number of patients	429	48
Age (years)	76.00 [70.00–82.00]	81.00 [77.00–86.00]	<0.001
Sex			0.222
Males	318 (74.1)	40 (83.3)
Females	111 (25.9)	8 (16.7)
Number of hospitalizations due to AE in the past year	1.00 [0.00–2.00]	2.00 [2.00–3.00]	<0.001
Comorbidities
DM	64 (14.9)	6 (12.5)	0.815
Hypertension	183 (42.7)	20 (41.7)	1.000
CHD	152 (35.6)	27 (56.2)	0.008
Heart failure	186 (43.4)	27 (67.5)	0.006
aCCI	5.00 [4.00–6.00]	6.00 [5.00–6.25]	<0.001
Laboratory tests
RDW-CV (%)	14.10 [13.10–15.00]	14.50 [13.73–15.30]	0.138
PLT (×10^9/L)	165.00 [128.00–220.00]	163.50 [126.50–215.50]	0.871
PLR	190.74 [117.36–317.70]	226.65 [135.89–385.69]	0.169
ChE (U/L)	5295.00 [4116.00–6737.00]	3211.50 [2922.75–4203.25]	<0.001
Alb (g/L)	37.25 [34.00–40.50]	32.50 [29.70–35.93]	<0.001
CREA (μmol/L)	74.70 [59.30–96.85]	84.05 [59.15–123.70]	0.203
CRP (mg/mL)	15.90 [3.90–65.30]	37.10 [13.78–102.97]	0.057
PCT (ng/mL)	0.08 [0.05–0.56]	0.11 [0.05–0.86]	0.838
OI	274.28 [205.00–346.80]	212.00 [156.75–267.92]	<0.001
PCO2 (mmHg)	44.03 [34.20–59.70]	52.80 [36.55–66.85]	0.057
pH	7.40 [7.35–7.44]	7.36 [7.28–7.42]	0.004
Lac (mmol/L)	1.20 [0.90–1.60]	1.00 [0.78–1.82]	0.256
Secondary outcomes
Hypercapnia	175 (40.8)	30 (62.5)	0.006
NIV	96 (22.4)	22 (45.8)	0.001
MV	18 (4.2)	10 (20.8)	<0.001
ICU Admission	34 (7.9)	14 (29.2)	<0.001
LOS (days)	10.00 [8.00–14.00]	21.50 [11.75–34.50]	<0.001

Abbreviations: DM, diabetes mellitus; CHD, coronary heart disease; aCCI, age-adjusted Charlson comorbidity index; RDW-CV, coefficient of variation of red blood cell distribution width; PLT, platelet; PLR, platelet-to-lymphocyte ratio; ChE, serum cholinesterase; Alb, albumin; CREA, serum creatinine; CRP, serum C-reactive protein; PCT, procalcitonin; OI, oxygenation index; PCO₂, partial pressure of carbon dioxide; Lac, blood lactate; Hypercapnia, PCO₂ > 45 mmHg; NIV, noninvasive ventilation; MV, mechanical ventilation; IQR, interquartile range; LOS, length of stay.

Figure 3. ROC curve analysis of the clinical value of serum cholinesterase levels in predicting the in-hospital mortality of patients with AECOPD. Abbreviations: ROC, receiver operating characteristic; AUC, area under the ROC curve; CI, confidence interval.

Table 2. Patient characteristics stratified by the serum cholinesterase levels.

Characteristics	ChE ≤ 4323 U/L	ChE > 4323 U/L	P value
Number of patients	161	316
Age (years)	78.00 [73.00–83.00]	76.00 [69.00–82.25]	0.006
Sex			0.205
Male	127 (78.9)	231 (73.1)
Female	34 (21.1)	85 (26.9)
Number of hospitalizations due to AE in the past year	1.00 [1.00–2.00]	1.00 [0.00–2.00]	0.025
Comorbidities
DM	15 (9.3)	55 (17.4)	0.026
Hypertension	53 (32.9)	150 (47.5)	0.003
CHD	69 (42.9)	110 (35.0)	0.117
Heart failure	96 (61.9)	117 (37.3)	<0.001
aCCI	5.00 [4.00–6.00]	5.00 [4.24–6.00]	<0.001
Laboratory tests
RDW-CV (%)	14.70 [13.60–16.00]	13.90 [13.10–14.70]	<0.001
PLT (*10^9/L)	158.00 [115.00–238.00]	169.00 [131.00–212.50]	0.229
PLR	224.30 [148.55–369.86]	177.35 [113.21–283.72]	0.002
Alb (g/L)	32.75 [29.65–36.20]	38.40 [35.70–41.60]	<0.001
CREA (μmol/L)	77.30 [58.40–121.13]	74.50 [59.55–91.30]	0.048
CRP (mg/mL)	36.75 [9.85–115.53]	12.10 [2.90–48.00]	<0.001
PCT (ng/mL)	0.24 [0.05–0.86]	0.05 [0.05–0.21]	<0.001
OI	240.60 [168.00–289.00]	285.05 [207.88–358.22]	<0.001
OI level			<0.001
≥300	34 (21.1)	148 (46.8)
200–299	74 (46.0)	103 (32.6)
100–199	42 (26.1)	61 (19.3)
≤99	11 (6.8)	4 (1.3)
PCO2 (mmHg])	50.39 [35.10–66.90]	42.85 [34.20–57.58]	0.019
pH	7.39 [7.32–7.44]	7.40 [7.36–7.44]	0.187
Lac (mmol/L)	1.23 [0.90–1.84]	1.13 [0.90–1.60]	0.194
Secondary outcomes
Hypercapnia	85 (52.8)	120 (38.0)	0.003
NIV	62 (38.5)	56 (17.7)	<0.001
MV	21 (13.0)	7 (2.2)	<0.001
ICU Admission	33 (20.5)	15 (4.7)	<0.001
LOS (days)	12.00 [9.00–19.00]	10.00 [7.00–13.25]	<0.001

Abbreviations: ChE, serum cholinesterase; DM, diabetes mellitus; CHD, coronary heart disease; aCCI, age-adjusted Charlson comorbidity index; RDW-CV, coefficient of variation of red blood cell distribution width; PLT, platelet; PLR, platelet-to-lymphocyte ratio; Alb, albumin; CREA, serum creatinine; CRP, serum c-reactive protein; PCT, procalcitonin; OI, oxygenation index; PCO₂, partial pressure of carbon dioxide; Lac, blood lactate; Hypercapnia, PCO₂ > 45 mmHg; NIV, noninvasive ventilation; MV, mechanical ventilation; IQR, interquartile range, LOS, length of stay.

Figure 4. Calibration curve of the multivariate logistic regression model. As shown, the calibration curve demonstrates satisfactory goodness of fit for the multivariate logistic regression model.

Table 3. Univariate and multivariate logistic regression analyses of potential risk factors associated with the in-hospital mortality of AECOPD patients.

Characteristics	Univariate		Multivariate
	OR (95% CI)	P value	OR (95% CI)	P value
Age (years)
>65/≤65	1.42 (0.54–4.85)	0.520
aCCI	1.74 (1.33–2.29)	<0.001	1.42 (1.03-2.00)	0.037
Number of hospitalizations due to AE in the past year	1.99 (1.55–2.59)	<0.001	2.37 (1.70-3.41)	<0.001
Alb (g/L)
≤35/>35	4.77 (2.55–9.32)	<0.001	2.6 (1.13-6.36)	0.029
ChE (U/L)
≤4323/>4323	10.90 (5.35–24.62)	<0.001	9.09 (3.43–28.3)	<0.001
Lac (mmol/L)
≥2/<2	1.37 (0.62–2.79)	0.402
pH (%)
7.20–7.35/≥7.35	2.58 (1.32–4.96)	0.005
≤7.20/≥7.35	11.45 (3.46–37.10)	<0.001
Hypercapnia	2.42 (1.32–4.55)	0.004	1.18 (0.51-2.78)	0.7
OI level		<0.001
200–299/≥300	3.73 (1.63–9.63)	0.003	1.88 (0.68-5.79)	0.2
100–199/≥300	2.98 (1.14–8.36)	0.028	1.74 (0.52-6.17)	0.4
≤99/≥300	21.8 (6.21–80.7)	<0.001	3.47 (0.57-20.3)	0.2

Abbreviations: aCCI, age-adjusted Charlson comorbidity index; Alb, albumin; ChE, serum cholinesterase; Lac, blood lactate; Hypercapnia, PCO₂ > 45 mmHg; OI, oxygenation index, OR, odds ratio; CI, confidence interval.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, Zhixiang Chen.