Serum concentration of chromogranin A at admission: An early biomarker of severity in critically ill patients

Figures & data

Table

AUC	area under curve
CRP	C-reactive protein
ICU	intensive care unit
ROC	receiver operating characteristic curve

Figure 1.  Flow chart of the study. A total of 100 consecutive intensive care unit (ICU) admissions over a 2-month period were screened and 14 healthy controls from our medical staff were also analyzed. Patients were excluded who had former chronic renal, hepatic, or cardiac failures, if they were undergoing treatment with steroids or proton pump inhibitors and if they had a medical history with neuroendocrine tumors. Finally, patients with recent multiple stress or a surgical intervention were also excluded.

Table I.  Characteristics of participants. Data are mean values±SEM. Pairwise comparisons are shown.

	Controls (n=23)		SIRS without infection	Infection with SIRS (n=31)
Characteristics	HC (n=14)	NSNI (n=9)	SIRS (n=13)	S (n=9)	SS (n=8)	SSH (n=14)
Age (yr)	37.6±2.8	64.4±6.8	66.5±5.2	71.9±4.0	70.1±4.4	69.6±2.8
Male sex (%)	57.1	66.7	69.2	66.7	62.5	71.2
SAPS II	ND	39.2±5.0	53.6±3.9	39.7±4.3	47.0±2.1	73.4±4.0^b
Mechanical ventilation (%)	ND	22.2	76.9^b	55.6	50	100^b
Time from first organ dysfunction to admission (h)	ND	26.7±6.9	52.6±23.6	57.3±11.4	31.5±10.6	35.4±7
Mean ICU stay (days)	ND	11.9±3.2	22.2±8.6	11.2±3.1	11.9±3.5	18±3.3
Mortality (%)	0	11.1	23.1	11.1	25	50^a

^aP<0.05; ^bP<0.01 versus other subgroups.

HC = healthy controls; ICU = intensive care unit; ND = not determined; NSNI = patients without systemic inflammatory response syndrome (SIRS) or infection; S = sepsis patients; SAPS = Simplified Acute Physiological Score; SIRS = patients with SIRS but without infection; SS = severe sepsis patients; SSH = septic shock patients.

Table II.  Biological values in the study population. Data are median (interquartile range). The comparisons are versus the healthy control group (HC).

	Controls (n=23)		SIRS without infection (n=13)	Infection with SIRS (n=31)
	HC	NSNI	SIRS alone	S	SS	SSH
Chromogranin A (µg/L)	39.5	53.0	110.0^a	70.0^a	77.5^a	212.5^b
	(35.0–49.8)	(34.0–92.0)	(81.0–143.0)	(60.0–129.0)	(56–187.5)	(106.8–276.5)
C-reactive protein (mg/L)	<4	7.3	68.8	47.7	96.6	105.7
		(4.0–18.8)	(20.3–96.1)	(29.5–88.8)	(14.9–183.3)	(46.7–153.9)
Procalcitonin (µg/L)	<0.1	0.3	0.6	0.41	2.1	28.6
		(0.1–0.5)	(0.2–6.8)	(0.3–5.7)	(0.2–6.7)	(18.0–31.6)
White blood cells (giga/L)	7.5	13.4	13.7	8.9	13.15	13.6
	(6.463–8.625)	(10.8–14.3)	(12.3–15.7)	(7.7–14.8)	(11.55–17.85)	(11.55–16.7)
Creatinine (µmol/L)	<50	107	124	137	139	233
		(88–160)	(87–245)	(94–144)	(106–170)	(157.3–608.3)

^aP<0.05 versus HC. ^bP<0.001 versus HC. Significant differences are not indicated for other parameters.

HC = healthy controls; NSNI = patients without systemic inflammatory response syndrome (SIRS) or infection; S = sepsis patients; SIRS = patients with SIRS but without infection; SS = severe sepsis patients; SSH = septic shock patients.

Figure 2.  Serum concentrations of chromogranin A (CGA) on admission in critically ill patients. Controls (SIRS-, Infection -; n=23) included healthy controls (n = 14) and patients with self-poisoning (n=9) without SIRS; SIRS patients (SIRS+, Infection-; n=13) were those with systemic inflammatory response syndrome from non-septic origin; septic patients (n=31) are in gray. The medians (interquartile ranges) for the three groups were 40.0 µg/L (35.0–52.5) for controls, 110.0 µg/L (81.0–143.0) for SIRS patients, and 138.5 µg/L (65–222.3) for septic patients respectively. * P < 0.01; # P < 0.001.

Figure 3.  Influence of serum chromogranin A (CGA) concentration at admission on survival time. Kaplan-Meier analysis in the ICU patients (n=53) with inframedian (dashed line) or supramedian (solid line) values (71 µg/L). These data confirmed that the lower the serum concentration on admission, the longer the survival time (log rank test, P=0.0013). Survival time is plotted against survival rate.