Prognostic value of chromogranin A at admission in critically ill patients: a cohort study in a medical intensive care unit.
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.
Zhang
Dan
D
Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Lavaux
Thomas
T
Voegeli
Anne-Claire
AC
Lavigne
Thierry
T
Castelain
Vincent
V
Meyer
Nicolas
N
Sapin
Rémy
R
Aunis
Dominique
D
Metz-Boutigue
Marie-Hélène
MH
Schneider
Francis
F
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D053379:Chromogranin A / Q000097:blood*; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D015996:Survival Rate
D015415:Biomarkers; D053379:Chromogranin A