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Objective To investigate the relationship between serum cholinesterase(ChE) and acute-phase proteins in patients with multiple trauma, then to evaluate their significance to judge prognosis. Method It's a prospective observation study. Patients with multiple trauma admitted to emergency intensive care unit,Second Af-filiated Hospital, Zhejiang Universieg, school of medicihe within 24 h after trauma from Oct. 2005 to Oct. 2007 were enrolled. And those with chronic liver disease, touching orgnaophosphorus, active tuberculosis, tumor, in-fection of major organ before trauma, liver injury or age < 18 year were excluded. Among 81 patients, 57 were male and24 female. The average age was (46±18) years, and the average injury severity score was (34.0±11.9).Seventy six healthy were selected as controls, 53 male and 23 female, with an average age of (44±16)years. The exclusion standards were the same as those in patients. Both groups had same gender proportion and age. Senum ChE and acute-phase proteins(APP) including albumin(ALB), prealbumin(PAB), transferrin(TRF),C-reactive protein(CRP) in patients were detected at 1, 3, 7 d after trauma. The acute physiology and chronic health evaluation Ⅲ (APACHEⅢ) was recorded simuhancously. Serum ChE, ALB, PAB, TRF, CRP in the controls were also detected. All of these indexes in the controls were compared with thoses in patients by t test or rank surn test. The dynamic changes of serum ChE and APPs in patients were analyzed by one way repeated mea-sures ANOVA. The relationships between serum ChE and those APPs and the relationships between APACHE Ⅲ and these indexes were analyzed by Pearson correlation analysis. We also compared these indexes between patients with different outcomes by t test or rank sum test. The values of serum ChE and those APPs to judge prognosis were evaluated by logistic regression analysis. Results Patients had lower serum ChE, ALB, PAB, TRF and higher CRP than the healthy at 1, 3, 7 d post trauma. Serum ChE activity in patients was reducod over 25% (42.3%～50.2%) than that in the healthy, and showed a tendency to decrease after trauma, which resembled PAB and TRF. Serum ChE was positively correlated with ALB, PAB and TRF at 1, 3, 7 d, and negatively correlated with CRP at 3, 7 d. At 1, 3, 7 d post trauma, APACHEⅢ in patients was negatively correlated with serum ChE and TRF, but negatively correlated with ALB only at 1 d, and negatively correlated with PAB only at 1,7 d, and posi-tively correlated with CRP only at 7 d. Non-survivors had lower serum ChE activity and TRF than survivors at 1,3,7 d after trauma, but had lower ALB only at 7 d after trauma and had lower PAB only at 1,7 d after trauma than survivors, and had higher CRP than survivors only at 7 d after trauma. Logistic regression analysis showed serum ChE and PAB were the only two independent risk factors to judge prognosis. Conclusions Serum ChE may be in-cluded as negative acute-phase protein, and is better than other APPs in reflecting injury severity and prognosis in patients with multiple trauma.