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Prognostic value of chromogranin A at admission in critically ill patients: a cohort study in a medical intensive care unit.

Abstract：

BACKGROUND:Risk assessments of patients should be based on objective variables, such as biological markers that can be measured routinely. The acute response to stress causes the release of catecholamines from the adrenal medulla accompanied by chromogranin A (CGA). To date, no study has evaluated the prognostic value of CGA in critically ill intensive care unit patients. METHODS:We conducted a prospective study of intensive care unit patients by measuring serum procalcitonin (PCT), C-reactive protein (CRP), and CGA at the time of admission. Univariate and multivariate analyses were performed to evaluate the ability of these biomarkers to predict mortality. RESULTS:In 120 consecutive patients, we found positive correlations between CGA and the following: CRP (r(2) = 0.216; P = 0.02), PCT (r(2) = 0.396; P < 0.001), Simplified Acute Physiologic Score II (SAPS II) (r(2) = 0.438; P < 0.001), and the Logistic Organ Dysfunction System (LODS) score (r(2) = 0.374; P < 0.001). Nonsurvivors had significantly higher CGA and PCT concentrations than survivors [median (interquartile range): 293.0 microg/L (163.5-699.5 microg/L) vs 86.0 microg/L (53.8-175.3 microg/L) for CGA, and 6.78 microg/L (2.39-22.92 microg/L) vs 0.54 microg/L (0.16-6.28 microg/L) for PCT; P < 0.001 for both comparisons]. In a multivariable linear regression analysis, creatinine (P < 0.001), age (P < 0.001), and SAPS II (P = 0.002) were the only significant independent variables predicting CGA concentration (r(2) = 0.352). A multivariate Cox regression analysis identified 3 independent factors predicting death: log-normalized CGA concentration [hazard ratio (HR), 7.248; 95% confidence interval (CI), 3.004-17.487], SAPS II (HR, 1.046; 95% CI, 1.026-1.067), and cardiogenic shock (HR, 3.920; 95% CI, 1.731-8.880). CONCLUSIONS:CGA is a strong and independent indicator of prognosis in critically ill nonsurgical patients.

journal_name

Clin Chem

journal_title

Clinical chemistry

authors

Zhang D,Lavaux T,Voegeli AC,Lavigne T,Castelain V,Meyer N,Sapin R,Aunis D,Metz-Boutigue MH,Schneider F

doi

10.1373/clinchem.2007.102442

subject

Has Abstract

pub_date

2008-09-01 00:00:00

pages

1497-503

issue

eissn

0009-9147

issn

1530-8561

pii

clinchem.2007.102442

journal_volume

pub_type

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Prognostic value of chromogranin A at admission in critically ill patients: a cohort study in a medical intensive care unit.