title: 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.
authors.affiliation: Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhang
authors.forename: Thomas
authors.initials: T
authors.lastname: Lavaux
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Voegeli
authors.forename: Thierry
authors.initials: T
authors.lastname: Lavigne
authors.forename: Vincent
authors.initials: V
authors.lastname: Castelain
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.forename: Rémy
authors.initials: R
authors.lastname: Sapin
authors.forename: Dominique
authors.initials: D
authors.lastname: Aunis
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Metz-Boutigue
authors.forename: Francis
authors.initials: F
authors.lastname: Schneider
mesh_terms: 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
chemical_list: D015415:Biomarkers; D053379:Chromogranin A