<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8909</journal-id>
<journal-title><![CDATA[Medicina crítica (Colegio Mexicano de Medicina Crítica)]]></journal-title>
<abbrev-journal-title><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></abbrev-journal-title>
<issn>2448-8909</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Medicina Crítica A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-89092018000500285</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Los niveles de acetilcolinesterasa en pacientes con inestabilidad hemodinámica descartan sepsis como causa de choque]]></article-title>
<article-title xml:lang="en"><![CDATA[The levels of acetylcholinesterase in patients with hemodynamic instability discard sepsis as a cause of shock]]></article-title>
<article-title xml:lang="pt"><![CDATA[Níveis de acetilcolinesterase em pacientes com instabilidade hemodinâmica descartam sepse como causa de choque]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Monares Zepeda]]></surname>
<given-names><![CDATA[Enrique]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ojeda Izquierdo]]></surname>
<given-names><![CDATA[Edgar Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zamora Palma]]></surname>
<given-names><![CDATA[Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Galindo Martín]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cuesta Torres]]></surname>
<given-names><![CDATA[Julia Cumandá]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital San Ángel Inn Universidad  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital General de México «Dr. Eduardo Liceaga»  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2018</year>
</pub-date>
<volume>32</volume>
<numero>5</numero>
<fpage>285</fpage>
<lpage>289</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092018000500285&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092018000500285&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092018000500285&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  La detección temprana de sepsis es fundamental para disminuir la mortalidad de este padecimiento. Hasta el momento, ninguna escala clínica ni biomarcador ha sido útil en su diagnóstico y detección precoz. Los niveles de actividad de la acetilcolinesterasa se han propuesto como un biomarcador muy prometedor para la detección de sepsis y choque séptico.  Objetivo:  Estudiar la utilidad de los niveles de acetilcolinesterasa en el diagnóstico de sepsis.  Material y métodos:  Estudio observacional y prospectivo, en pacientes de la Unidad de Cuidados Intensivos del Hospital San Ángel Inn Universidad con diagnóstico de inestabilidad hemodinámica, clasificados con presencia o no de sepsis, tomándose niveles de acetilcolinesterasa al ingreso.  Resultados:  Se evaluaron 44 pacientes, 27% con sepsis. Los valores de acetilcolinesterasa tuvieron validez diagnóstica para predecir sepsis (AUC: 0.852 IC 95%: 0.726-0.977, p &lt; 0.001), con un punto de corte de 3,956 U/L, sensibilidad = 81%, especificidad = 75%. El valor de neutrófilos con corte &lt; 74% también tuvo valor predictor de sepsis (AUC: 0,710 IC 95%: 0,512-0,907, p = 0.034) sensibilidad = 75%, especificidad = 75%.  Conclusiones:  En pacientes con inestabilidad hemodinámica con niveles de acetilcolinesterasa mayores de 4,000 U/L se descarta sepsis como causa de choque.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Early detection of sepsis is essential to reduce mortality from this condition. So far, no clinical scale or biomarker has been useful in its diagnosis and early detection. Levels of acetylcholinesterase activity have been proposed as a very promising biomarker for the detection of sepsis and septic shock.  Objective:  To study the usefulness of acetylcholinesterase levels in the diagnosis of sepsis.  Material and methods:  Observational and prospective study in patients of the Intensive Care Unit of the Hospital San Ángel Inn Universidad with diagnosis of hemodynamic instability, classified with or without sepsis, taking acetylcholinesterase levels at admission.  Results:  44 patients were evaluated, 27% with sepsis. The acetylcholinesterase values &#8203;&#8203;presented a normal distribution and had diagnostic validity to predict sepsis (AUC: 0.852 95% CI: 0.726-0.977, p &lt; 0.001), with a cut-off value of &lt; 3,956 U/L, sensitivity = 81%, specificity = 75%. The value of neutrophils with a cut &lt; 74% also had a predictive value of sepsis (AUC: 0.710 95% CI: 0.512-0.907, p = 0.034) sensitivity = 75%, specificity = 75%.  Conclusions:  In patients with hemodynamic instability with acetylcholinesterase levels greater than 4,000 U/L, sepsis is ruled out as the cause of shock.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  A detecção precoce da sepse é fundamental para reduzir a mortalidade desta doença. Até agora nenhuma escala clínica ou biomarcador tem sido útil em seu diagnóstico e detecção precoce. Os níveis de atividade da acetilcolinesterase têm sido propostos como um biomarcador muito promissor para a detecção de sepse e choque séptico.  Objetivo:  Estudar a utilidade dos níveis de acetilcolinesterase no diagnóstico da sepse.  Material e métodos:  Estudo observacional e prospectivo, realizado em pacientes da unidade de terapia intensiva do Hospital Universitário San Ángel Inn, com diagnóstico de instabilidade hemodinâmica, classificados com ou sem a presença de sepse, obtendo os níveis de acetilcolinesterase na admissão.  Resultados:  Foram avaliados 44 pacientes, 27% com sepse. Os valores de acetilcolinesterase apresentaram validade diagnóstica para predizer sepse (AUC: 0.852 IC 95%: 0.726-0.977, p &lt; 0.001), com valor de corte 3956 U/L, sensibilidade = 81%, especificidade = 75%. O valor de neutrófilos com um corte &lt; 74% também teve um valor preditivo de sepsis (AUC: 0.710 IC 95%: 0.512-0.907, p = 0.034) sensibilidade = 75%, especificidade = 75%.  Conclusões:  Em pacientes com instabilidade hemodinâmica com níveis de acetilcolinesterase superiores a 4,000 U/L a sepse é descartada como causa de choque.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Actividad de acetilcolinesterasa sérica]]></kwd>
<kwd lng="es"><![CDATA[biomarcador]]></kwd>
<kwd lng="es"><![CDATA[sepsis]]></kwd>
<kwd lng="es"><![CDATA[choque séptico]]></kwd>
<kwd lng="es"><![CDATA[SIRS]]></kwd>
<kwd lng="en"><![CDATA[Serum acetylcholinesterase activity]]></kwd>
<kwd lng="en"><![CDATA[biomarker]]></kwd>
<kwd lng="en"><![CDATA[sepsis]]></kwd>
<kwd lng="en"><![CDATA[septic shock]]></kwd>
<kwd lng="en"><![CDATA[SIRS]]></kwd>
<kwd lng="pt"><![CDATA[Atividade da acetilcolinesterase sérica]]></kwd>
<kwd lng="pt"><![CDATA[biomarcador]]></kwd>
<kwd lng="pt"><![CDATA[sepse]]></kwd>
<kwd lng="pt"><![CDATA[choque séptico]]></kwd>
<kwd lng="pt"><![CDATA[SIRS]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Uzzan]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Cohen]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Nicolas]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Cucherat]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Perret]]></surname>
<given-names><![CDATA[GY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis]]></article-title>
<source><![CDATA[Crit Care Med]]></source>
<year>2006</year>
<volume>34</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>1996-2003</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rosas-Ballina]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Tracey]]></surname>
<given-names><![CDATA[KJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cholinergic control of inflammation]]></article-title>
<source><![CDATA[J Intern Med]]></source>
<year>2009</year>
<volume>265</volume>
<page-range>663-79</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Berthoud]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
<name>
<surname><![CDATA[Neuhuber]]></surname>
<given-names><![CDATA[WL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Functional and chemical anatomy of the afferent vagal system]]></article-title>
<source><![CDATA[Auton Neurosci]]></source>
<year>2000</year>
<volume>85</volume>
<page-range>1-17</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Yu]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ochani]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Amella]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
<name>
<surname><![CDATA[Tanovic]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Susarla]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nicotinic acetylcholine receptor alpha7 subunit is an essential regulator of inflammation]]></article-title>
<source><![CDATA[Nature]]></source>
<year>2003</year>
<volume>421</volume>
<numero>6921</numero>
<issue>6921</issue>
<page-range>384-8</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bahloul]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Baccouch]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Chtara]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Turki]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Turki]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Ben Hamida]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Value of serum cholinesterase activity in the diagnosis of septic shock due to bacterial infections]]></article-title>
<source><![CDATA[J Intensive Care Med]]></source>
<year>2016</year>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Feng]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Tang]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Guo]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Bao]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Wen]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Xue]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prognostic value of serum cholinesterase activities in sepsis patients]]></article-title>
<source><![CDATA[Hepatogastroenterology]]></source>
<year>2012</year>
<volume>60</volume>
<numero>125</numero>
<issue>125</issue>
<page-range>1001-5</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Oznur]]></surname>
<given-names><![CDATA[Koylu]]></given-names>
</name>
<name>
<surname><![CDATA[Mehmet]]></surname>
<given-names><![CDATA[Yortanli]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The effect of cholinesterase activity on the diagnosis and prognosis of sepsis]]></article-title>
<source><![CDATA[Clinical Medicine Research]]></source>
<year>2016</year>
<volume>5</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>28-34</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Singer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Deutschman]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Seymour]]></surname>
<given-names><![CDATA[CW]]></given-names>
</name>
<name>
<surname><![CDATA[Shankar-Hari]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Annane]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Bauer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The third international consensus definitions for sepsis and septic shock (Sepsis-3)]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2016</year>
<volume>315</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>801-10</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lawton]]></surname>
<given-names><![CDATA[LD]]></given-names>
</name>
<name>
<surname><![CDATA[Roncal]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Leonard]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Stack]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Dinh]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Byrne]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The utility of Advanced Trauma Life Support (ATLS) clinical shock grading in assessment of trauma]]></article-title>
<source><![CDATA[Emerg Med J]]></source>
<year>2014</year>
<volume>31</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>384-9</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Levy]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Bastien]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Karim]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Cariou]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Chouihed]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Combes]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Experts&#8217; recommendations for the management of adult patients with cardiogenic shock]]></article-title>
<source><![CDATA[Ann Intensive Care]]></source>
<year>2015</year>
<volume>5</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>52</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Al-Kassab]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Vijayakumar]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Profile of serum cholinesterase in systemic sepsis syndrome (septic shock) in intensive care unit patients]]></article-title>
<source><![CDATA[Clinical Chemistry and Laboratory Medicine]]></source>
<year>1995</year>
<volume>33</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>11-4</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chiarla]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Giovannini]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Giuliante]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Vellone]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ardito]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Nuzzo]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Plasma cholinesterase correlations in acute surgical and critical illness]]></article-title>
<source><![CDATA[Minerva Chirurgica]]></source>
<year>2011</year>
<volume>66</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>323-7</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
