title: Prognostic value of chromogranin A in severe sepsis: data from the FINNSEPSIS study.
abstract: OBJECTIVE
  To assess the prognostic information of chromogranin A (CgA), a marker associated with adrenergic tone and myocardial function, in patients with severe sepsis.
  
  
  METHODS
  CgA levels were measured at the time of study inclusion and 72 h later in 232 patients with severe sepsis recruited from 24 ICUs in Finland (FINNSEPSIS study).
  
  
  RESULTS
  Sixty-five patients (28%) died during the index hospitalization. CgA levels at inclusion and after 72 h correlated with several established indices of risk in sepsis. Patients who died during the hospitalization had higher baseline CgA levels than hospital survivors: 14.0 (Q1-3, 7.4-27.4) versus 9.1 (5.9-15.8) nmol/l, P = 0.002, and after 72 h: 16.2 (9.0-31.1) versus 9.8 (6.0-18.0) nmol/l, P = 0.001. Prior cardiovascular disease (P = 0.04) and cardiovascular SOFA levels on day 3 (P = 0.03) were associated with higher CgA levels after 72 h by linear regression. CgA levels on study inclusion and after 72 h were independently associated with hospital mortality by logistic regression: OR (logarithmically transformed CgA levels) 1.95 (95% CI 1.01-3.77), P = 0.046 and OR 2.03 (95% CI 1.18-3.49), P = 0.01, respectively. The prognostic accuracy was comparable for CgA measurements and SAPS II score, and the addition of CgA measurements to the SAPS II score improved risk stratification of the patients as assessed by the category-free net reclassification index. A CgA level >6.6 nmol/l on study inclusion was associated with septic shock during the hospitalization.
  
  
  CONCLUSIONS
  CgA levels measured during hospitalization for severe sepsis are associated with cardiovascular dysfunction and may provide additional prognostic information in patients with severe sepsis.
authors.affiliation: Division of Medicine, Akershus University Hospital, Sykehusveien 27, 1478, Lørenskog, Norway. helge.rosjo@medisin.uio.no
authors.forename: Helge
authors.initials: H
authors.lastname: Røsjø
authors.forename: Ståle
authors.initials: S
authors.lastname: Nygård
authors.forename: Kirsi-Maija
authors.initials: KM
authors.lastname: Kaukonen
authors.forename: Sari
authors.initials: S
authors.lastname: Karlsson
authors.forename: Mats
authors.initials: M
authors.lastname: Stridsberg
authors.forename: Esko
authors.initials: E
authors.lastname: Ruokonen
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002319:Cardiovascular System / Q000503:physiopathology; D053379:Chromogranin A / Q000097:blood*; D005260:Female; D005387:Finland; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D018805:Sepsis / Q000097:blood / Q000503:physiopathology*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D053379:Chromogranin A