Evidence-Based Medicine
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 8, 2017; 9(22): 967-972
Published online Aug 8, 2017. doi: 10.4254/wjh.v9.i22.967
Serum cholinesterase: A predictive biomarker of hepatic reserves in chronic hepatitis D
Minaam Abbas, Zaigham Abbas
Minaam Abbas, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0SP, United Kingdorm
Minaam Abbas, Zaigham Abbas, Department of Medicine, Orthopedic and Medical Institute, Karachi 74400, Pakistan
Author contributions: Abbas M was responsible for the study conception and design; Abbas Z identified patients for the study; both authors contributed to the data analysis, interpretation and manuscript drafting; and they critically reviewed the paper and approved the final version to be submitted for publication.
Institutional review board statement: Retrospective chart reviews were approved by the Ethics Review Committee of OMI.
Conflict-of-interest statement: The authors declare no potential conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Zaigham Abbas, FCPS, FRCP, Department of Medicine, Orthopedic and Medical Institute, Depot Lines, Karachi 74400, Pakistan. drzabbas@gmail.com
Telephone: +92-21-32226214 Fax: +92-21-32251814
Received: January 18, 2017
Peer-review started: January 20, 2017
First decision: March 13, 2017
Revised: March 19, 2017
Accepted: June 12, 2017
Article in press: June 13, 2017
Published online: August 8, 2017

To determine the predictive performance of cholinesterase compared to existing prognostic models in evaluating liver function in patients with chronic hepatitis D.


In an observational, cross-sectional and retrospective study, consecutive patients with hepatitis D cirrhosis were evaluated. Demographic, clinical and laboratory parameters were recorded. Serum cholinesterase levels were correlated with existing scoring models for chronic liver disease and Liver function tests. Receiver operating characteristic (ROC) curves were constructed to find an optimal cholinesterase level predicting ascites, Child Turcotte Pugh (CTP) score ≥ 10, model for end stage liver disease (MELD) score ≥ 15, baseline-event-anticipation (BEA) score for hepatitis D ≥ 5 and the aspartate transaminase to Platelet Ratio Index (APRI) ≥ 1.5.


This study investigated 233 patients with chronic liver disease due to hepatitis D; 192 were male, median age 42 (16-69 years). Fifty patients had ascites and 15 had encephalopathy. One hundred and sixty-seven (71.7%) were in Child class A, 52 (22.3%) in Child class B and 14 (5.0%) in class C. A MELD score of 15 or more was seen in 24 patients. Cholinesterase levels correlated well with the INR, albumin, CTP score, MELD, MELD sodium, BEA and APRI scores (P < 0.001 each). Area under the ROC curve for ascites, CTP ≥ 10, MELD ≥ 15, BEA ≥ 5, APRI ≥ 1.5 was 0.836, 0.966, 0.913, 0.871 and 0.825 respectively (P < 0.001 each). Cut off values of cholinesterase (IU/L) for predicting ascites, CTP ≥ 10, MELD ≥ 15, BEA ≥ 5 and APRI ≥ 1.5 were < 3812, < 2853, < 2829, < 4719 and < 3954 with a sensitivity of 80%, 100%, 91.67%, 82.50%, 58.0% and specificity of 81.97%, 84.79%, 87.56%, 77.06% and 55.64% respectively.


Serum cholinesterase demonstrates promising correlations with serum albumin, INR and CTP, MELD, BEA and APRI scores and is predictive of liver reserves in hepatitis D cirrhosis.

Keywords: Cholinesterase, Liver function, cirrhosis, Model for Endstage Liver Disease score, Aspartate transaminase-to-platelet ratio index, Hepatitis D, Child Turcotte Pugh score, Baseline-event-anticipation score

Core tip: Prognostic models to assess liver function in patients with chronic liver disease are used extensively in clinical settings. These systems employ multiple clinical and laboratory parameters to evaluate liver reserves and predict outcome. In our study we assessed cholinesterase as an independent predictor of hepatic reserves. We found that its values correlated strongly with Liver function tests and with the existing scoring models. Thereafter, we defined optimal cholinesterase levels corresponding to the different stages and classes of the scoring systems and hence the severity of chronic liver disease. The study’s subjects were patients suffering from cirrhosis due to hepatitis D.