Evaluation of the Pseudocholinestrase Activity as Marker for Severity of Liver Disease in Comparison with Child-Pugh Score in Liver Cirrhosis

Abstract

Cirrhosis is defined as a chronic disease of the liver in which diffuse destruction and regeneration of hepatic parenchyma cells have occurred, and in which a diffuse increase in connective tissues has resulted in disorganization of the lobular and vascular architecture. Major complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, portal hypertension, variceal bleeding, and hepatic encephalopathy, hepato cellular carcinoma. Prognostic models are useful in estimating liver disease severity and survival and are used to make decisions regarding specific medical interventions. The most important Prognostic models are Child-Pugh classification and MELD score, however ideal scoring system that is objective and not affected by other factors is not yet identified. Pseudocholinesterase is synthesized by the liver, and is found in the plasma, the pancreas, the heart and the brain. Significant deterioration in liver function may impair production of pseudocholinestrase, Improvement in liver function is concomitant with anincrease in pseudo-cholinesterase activity. This study was designed to evaluate the use of serum pseudocholinestrase activity as a marker for severity of liver disease. This is a cross sectional study conducted on 40 patients with liver cirrhosis. Patients were recruited from hepatology department of Kafr Eldawar hospital. All patients were subjected to the following: full history taking, physical examination, abdominal ultrasonography and the following laboratory investigations: CBC, liver function tests, renal function tests. The Child-Pugh score was calculated, the MELD score was computed according to the original formula for each patient and serum Pseudocholinestrase activity was measured. Patients were divided according to Child -Pugh score into Child A, B and C. Their MELD scores were calculated and then they were categorized according to MELD score at cut off point of MELD 14. Our results revealed that Child C patients have significant lower level of serum pseudocholinestase activity than patients with Child B and Child A. Patients with MELD score >14 have significant lower level of serum pseudocholinestase activity than patients with MELD score <14. There is significant negative correlation between serum pseudocholinestase activity and each of Child -Pugh score, age, prothrombin time and MELD score, also there is negative correlation between serum pseudocholinestase activity and serum bilirubin and serum albumin, however it was not statistically significant. We found that serum pseudocholinestrase activity is related to stage of liver disease severity according to child-pugh score, the difference in pseudocholinestrase activity between all groups was significant. We concluded that a decrease in serum ChE is clinically meaningful and serum ChE sensitively reflects a degree of chronic diffuse liver damage.