Vasostatin-I, a chromogranin A-derived peptide, in non-selected critically ill patients: distribution, kinetics, and prognostic significance.
OBJECTIVE
Chromogranin A (CGA) is released in the plasma during life-threatening illnesses. Its N-terminal 1-76 peptide, vasostatin-I (VS-I), has never been assessed in critically ill patients. Our aim was to examine whether the admission VS-I concentration has prognostic significance without having to specify a primary diagnosis.


METHODS
VS-I concentrations were assessed with a new ELISA in 481 consecutive patients and 13 healthy controls. CGA and standard biological tests (including lactate) were performed; the simplified acute physiological score II (SAPS II) was calculated. Mortality was assessed at day 28. In a subgroup of 13 patients with shock, serial VS-I doses were given over 60 h.


RESULTS
Critically ill patients had higher admission VS-I concentrations than controls [4.06 (2.78; 7.61) vs. 2.85 (2.47; 3.22) ng/ml, p < 0.001]. The plasma VS-I concentration was significantly lower in survivors than in non-survivors [3.70 (2.67; 6.12) vs. 5.75 (3.65; 11.20) ng/ml] and in the absence of shock [3.58 (2.59; 5.05) vs. 5.93 (3.30; 11.06) ng/ml, p < 0.001]. The survival rate was better in patients with VS-I concentrations under the median value of 3.97 ng/ml (p < 0.001). Admission VS-I and lactate values were independent predictors of mortality (p < 0.01). Moreover, taking them together, combined with age, provided a better indication for predicting mortality than taking each alone (p < 0.01).


CONCLUSIONS
Significant amounts of VS-I are detected on admission in critically ill patients. A plasma VS-I concentration above 3.97 ng/ml is associated with poor outcome, and in routine practice simultaneous measurements of the three independent factors VS-I, lactate and age can affect the assessment of severity.
Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg and INSERM U977, Université de Strasbourg, Strasbourg, France.
Francis
F
Schneider
Charlotte
C
Bach
Hélène
H
Chung
Luca
L
Crippa
Thomas
T
Lavaux
Pierre-Edouard
PE
Bollaert
Michel
M
Wolff
Angelo
A
Corti
Anne
A
Launoy
Xavier
X
Delabranche
Thierry
T
Lavigne
Nicolas
N
Meyer
Patrick
P
Garnero
Marie-Hélène
MH
Metz-Boutigue
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers; D053379:Chromogranin A / Q000032:analysis* / Q000493:pharmacokinetics / Q000494:pharmacology; D016638:Critical Illness; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis* / Q000493:pharmacokinetics / Q000494:pharmacology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies
D015415:Biomarkers; D053379:Chromogranin A; D010446:Peptide Fragments; C064110:vasostatin I