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Abstract
Background. Chromogranin A (CGA), a stress marker released with catecholamines by the adrenal medulla, has never been associated with acute inflammation in critically ill patients.
Aim. To determine evidence for a link between serum concentration of CGA, biomarkers of inflammation, and outcome in patients admitted with or without the systemic inflammatory response syndrome (SIRS).
Methods. At admission, we measured in 53 patients and 14 healthy controls the serum concentrations of CGA, procalcitonin, and C-reactive protein. We also assessed the Simplified Acute Physiological Score (SAPS) in the patients.
Results. Serum CGA concentrations were significantly increased in SIRS patients with a median value of 115 µg/L (68.0–202.8), when compared to 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 138.5 µg/L (65–222.3) (P<0.001). CGA concentrations positively correlated with inflammation markers (procalcitonin, C-reactive protein), but also with SAPS. Receiver operating characteristic (ROC) analysis showed that CGA is equivalent to SAPS as an indicator for 28-day mortality (area under curve (AUC) for both: 0.810).
Conclusions. Patients with CGA concentration superior to 71 µg/L have a significantly shorter survival. A Cox model confirmed that CGA and SAPS were independent predictors of outcome.
Acknowledgements
We acknowledge support of both the Délégation à la Recherche Clinique des Hôpitaux Universitaires de Strasbourg (grant n°3150, PHRC 2003) and the Department of Foreign Affairs (Charcot grant for DZ). This work was also funded by INSERM and the University Louis Pasteur (Strasbourg, France) and supported by the Fondation Transplantation (PhD grant to DZ). We thank Cisbio (Marcoule, France) for the gift of the CGA kits and Nathalie Mela for careful technical assistance (CNRS, UMR 7191 Institut de Physique Biologique, Strasbourg, France).
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. D. Zhang and T. Lavaux contributed equally to the writing.