title: Prognostic Value of Secretoneurin in Critically Ill Patients With Infections.
abstract: OBJECTIVE
  Secretoneurin is produced in neuroendocrine cells, and the myocardium and circulating secretoneurin levels provide incremental prognostic information to established risk indices in cardiovascular disease. As myocardial dysfunction contributes to poor outcome in critically ill patients, we wanted to assess the prognostic value of secretoneurin in two cohorts of critically ill patients with infections.
  
  
  METHODS
  Two prospective, observational studies.
  
  
  METHODS
  Twenty-four and twenty-five ICUs in Finland.
  
  
  METHODS
  A total of 232 patients with severe sepsis (cohort #1) and 94 patients with infections and respiratory failure (cohort #2).
  
  
  METHODS
  None.
  
  
  RESULTS
  We measured secretoneurin levels by radioimmunoassay in samples obtained early after ICU admission and compared secretoneurin with other risk indices. In patients with severe sepsis, admission secretoneurin levels (logarithmically transformed) were associated with hospital mortality (odds ratio, 3.17 [95% CI, 1.12-9.00]; p = 0.030) and shock during the hospitalization (odds ratio, 2.17 [1.06-4.46]; p = 0.034) in analyses that adjusted for other risk factors available on ICU admission. Adding secretoneurin levels to age, which was also associated with hospital mortality in the multivariate model, improved the risk prediction as assessed by the category-free net reclassification index: 0.35 (95% CI, 0.06-0.64) (p = 0.02). In contrast, N-terminal pro-B-type natriuretic peptide levels were not associated with mortality in the multivariate model that included secretoneurin measurements, and N-terminal pro-B-type natriuretic peptide did not improve patient classification on top of age. Secretoneurin levels were also associated with hospital mortality after adjusting for other risk factors and improved patient classification in cohort #2. In both cohorts, the optimal cutoff for secretoneurin levels at ICU admission to predict hospital mortality was ≈ 175 pmol/L, and higher levels were associated with mortality also when adjusting for Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores.
  
  
  CONCLUSIONS
  Secretoneurin levels provide incremental information to established risk indices for the prediction of mortality and shock in critically ill patients with severe infections.
authors.affiliation: 1Division of Medicine, Akershus University Hospital, Lørenskog, Norway.2Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.3Department of Medical Sciences, Uppsala University, Uppsala, Sweden.4Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway.5Bioinformatics core facility, University of Oslo and Oslo University Hospital, Oslo, Norway.6Department of Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.7Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.8Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland.9Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Helge
authors.initials: H
authors.lastname: Røsjø
authors.forename: Mats
authors.initials: M
authors.lastname: Stridsberg
authors.forename: Anett H
authors.initials: AH
authors.lastname: Ottesen
authors.forename: Ståle
authors.initials: S
authors.lastname: Nygård
authors.forename: Geir
authors.initials: G
authors.lastname: Christensen
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Rita
authors.initials: R
authors.lastname: Linko
authors.forename: Sari
authors.initials: S
authors.lastname: Karlsson
authors.forename: Tero
authors.initials: T
authors.lastname: Varpula
authors.forename: Esko
authors.initials: E
authors.lastname: Ruokonen
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D005387:Finland; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009479:Neuropeptides / Q000097:blood*; D063305:Organ Dysfunction Scores; D011014:Pneumonia / Q000097:blood / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D053381:Secretogranin II / Q000097:blood*; D018805:Sepsis / Q000097:blood* / Q000401:mortality*; D012737:Sex Factors
chemical_list: D009479:Neuropeptides; D053381:Secretogranin II; D020097:Natriuretic Peptide, Brain; C081159:secretoneurin