AUTHOR=Verras Georgios-Ioannis , Mulita Francesk 

TITLE=Butyrylcholinesterase levels correlate with surgical site infection risk and severity after colorectal surgery: a prospective single-center study

JOURNAL=Frontiers in Surgery

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2024.1379410

DOI=10.3389/fsurg.2024.1379410

ISSN=2296-875X

ABSTRACT=Introduction: Surgical site infections (SSI) after colorectal surgery remains a devastating event, which warrants effective predictive markers for prompt diagnosis and treatment. Butyrylcholinesterase (BChE), a non-specific cholinesterase enzyme has been correlated with risk for hepatic dysfunction progression, and more recently infectious diseases, septic shock with ongoing research into the utility of BChE in multiple systemic inflammatory conditions. Whether these preliminary results can be translated in predicting infection after colorectal surgery remains in remains in question. This prospective study aimed to assess BChE's utility as a potential prediction marker for surgical site infections, and anastomotic leak, after colorectal surgery. Materials and Methods: This single-center prospective study (11/2019-05/2023) enrolled 402 patients who underwent colorectal surgery. BChE levels were measured at four postoperative time points. Primary endpoints focused on BChE's association in complications, particularly surgical site infections (SSI).Further known predictors of SSI were utilized in order to construct multivariable models to assess for independent association with SSI development. Results: During the 3 rd and 5 th day post-surgery, SSI patients had significantly lower mean BChE levels (3.90 KU/L vs. 4.54 KU/Lp-value <0.05;, and 4.14 KU/L vs. 4.73 KU/L, p-value <0.05; t-test, respectively). However, multivariate analysis revealed that when adjusted for other factors, low BChE levels on the 1 st postoperative day were  associated with 2.6 times higher odds for developing SSI (OR: 2.6,).Similar results were found for low BChE levels on the 3 rd postoperative day as they were associated with a. 2.53 times higher odds for developing SSI (OR: 2.5, 95%CI: 1.27-3.87, p-value<0.05) when adjusted for other factors. Conclusion: In conclusion, in this prospective observational study low levels in the 1 st and 3 rd post-surgery were associated with an increased risk for the development of SSIs but not sepsis.