Prognostic Value of Chromogranin A at Admission in Critically Ill Patients: A Cohort Study in a Medical Intensive Care Unit

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 prognost...

Full description

Saved in:
Bibliographic Details
Published in:Clinical chemistry (Baltimore, Md.) Md.), 2008-09, Vol.54 (9), p.1497-1503
Main Authors: Zhang, Dan, Lavaux, Thomas, Voegeli, Anne-Claire, Lavigne, Thierry, Castelain, Vincent, Meyer, Nicolas, Sapin, Remy, Aunis, Dominique, Metz-Boutigue, Marie-Helene, Schneider, Francis
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Amino acids
Biomarkers - blood
Blood
Chromogranin A - blood
Clinical medicine
Cohort Studies
Critical care
Critical Illness
Female
Gene expression
Heart attacks
Hospitalization
Hospitals
Humans
Intensive care
Intensive Care Units
Male
Middle Aged
Monoclonal antibodies
Mortality
Patient Admission
Prognosis
Regression analysis
Survival Rate
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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. 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. 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). CGA is a strong and independent indicator of prognosis in critically ill nonsurgical patients.
ISSN:0009-9147
1530-8561
DOI:10.1373/clinchem.2007.102442