Correlation of serum acetyl cholinesterase with liver enzymes in organophosphorus poisoning

Abstract

Introduction: Organophosphorus (OP) poisoning is a significant public health concern, particularly in agricultural communities. While the neurotoxic effects of OP compounds through acetylcholinesterase (AChE) inhibition are well-established, their impact on hepatic function remains incompletely characterized. This study aimed to investigate the correlation between serum acetylcholinesterase levels and liver enzymes in patients with OP poisoning and evaluate their temporal evolution and prognostic significance. Methods: This prospective study included 100 patients with OP poisoning admitted to a tertiary care center. Serum acetylcholinesterase levels and liver function tests (SGOT, SGPT, ALP, total and direct bilirubin) were measured on days 1, 3, and 5 of hospitalization. Severity was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale. Clinical outcomes including need for intubation, mortality, and discharge status were recorded. Correlation analysis was performed to determine the relationship between AChE levels and liver function parameters. Results: The study population comprised 53% males and 47% females, with 63% of patients aged 21-40 years. On admission, 85% of patients had depressed AChE levels (<5320 U/L), while 86% had elevated SGOT, 77% had elevated SGPT, and 86% had elevated ALP. Strong negative correlations were observed between AChE levels and liver enzymes (SGOT: r=-0.812, SGPT: r=-0.814, ALP: r=-0.631, total bilirubin: r=- 0.704, direct bilirubin: r=-0.667; all p<0.001). Patients with depressed AChE levels

had significantly higher liver enzyme levels compared to those with normal AChE. Recovery patterns showed normalization of SGOT in all patients by day 5, while SGPT remained elevated in 48% and bilirubin levels showed paradoxical worsening. The overall mortality rate was 13%, with a trend toward better survival in patients with normal AChE levels, though this was not statistically significant (p=0.14). Conclusion: This study demonstrates a strong inverse correlation between serum acetylcholinesterase levels and liver enzymes in OP poisoning, indicating that hepatotoxicity parallels the degree of cholinesterase inhibition. The high prevalence of liver dysfunction and the varying temporal evolution of different parameters highlight the importance of comprehensive liver function monitoring in OP poisoning. These findings enhance our understanding of the multi-organ effects of OP compounds and may inform more targeted approaches to assessment and management of these patients.