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Chromogranin A expression in plasma of critically ill patients
Critical Care volume 14, Article number: P37 (2010)
Risk assessments of patients should be based on objective variables, such as biological markers that can be measured routinely. Such a prediction remains a difficult challenge. The acute response to stress causes the release of catecholamines from the chromaffin cells of the adrenal medulla accompanied by numerous proteins, peptides such as chromogranin A (CGA) and its natural fragments. To date, no study has evaluated the prognostic value of CGA in critically ill ICU patients.
We conducted a prospective study of ICU patients, admitted for a life-threatening condition with at least two organ failures, by measuring plasma procalcitonin (PCT), C-reactive protein (CRP), the Simplified Acute Physiological Score II (SAPS II), and CGA on the 24th hour after admission. Continuous data are reported as the median (interquartile range), and group differences were evaluated with the Mann-Whitney U test or the Kruskal-Wallis test. A Cox proportional hazards regression model was used to evaluate the effect of the logarithmically transformed CGA concentration on the endpoint and to calculate hazard ratios (HRs) with 95% CIs. All statistical analyses were performed with the SPSS statistical package (SPSS for Windows version 11.5).
In 120 consecutive patients, we found positive correlations between CGA and the following: CRP (r2 = 0.216; P = 0.02), PCT (r2 = 0.396; P < 0.001), SAPS II (r2 = 0.438; P < 0.001). Nonsurvivors had significantly higher CGA concentrations than survivors (median (interquartile range): 293 μg/l (163 to 699 μg/l) vs. 86 μg/l (54 to 175 μg/l), respectively; P < 0.001). Serum CGA concentrations were significantly increased in SIRS patients with a median value of 115 mg/l (68 to 202), when compared with healthy controls (P < 0.001). In cases where infection was associated with SIRS, patients had the highest increase in CGA with a median value of 138 mg/l (65 to 222; P < 0.001). See Figure 1. 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 (r2 = 0.352). A multivariate Cox regression analysis identified three independent factors predicting death: log-normalized CGA concentration (hazard ratio (HR), 7.25; 95% confidence interval (CI), 3.00 to 17.50), SAPS II (HR, 1.05; 95% CI, 1.03 to 1.07), and cardiogenic shock (HR, 3.92; 95% CI, 1.73 to 8.88).
The admission plasma CGA concentration is increased in the most severe critically ill patients; it correlates with the SAPS II measured after 24 hours and with inflammatory/infectious markers (PCT and CRP). It may be useful in establishing an early stratification for severity in nonselected critically ill patients with organ failures.
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Lavaux, T., Schneider, F., Bach, C. et al. Chromogranin A expression in plasma of critically ill patients. Crit Care 14, P37 (2010). https://doi.org/10.1186/cc9140
- Chromaffin Cell
- Acute Physiological Score
- Significant Independent Variable
- Multivariable Linear Regression Analysis