Received on December 20, 2007
Accepted on June 20, 2008

General Clinical Chemistry

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

¹ Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, and INSERM, Physiopathologie du Système Nerveux, Strasbourg, France, and First Hospital, Chongqing University of Medical Science, Chongqing, China
² >Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, and School of Medicine, Louis Pasteur University, Strasbourg, France
³ School of Medicine, Louis Pasteur University, Strasbourg, France
⁴ Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, and School of Medicine, Louis Pasteur University, Strasbourg, France
⁵ School of Medicine, Louis Pasteur University, Strasbourg, France, and Pôle de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
⁶ INSERM, Physiopathologie du Système Nerveux, Strasbourg, France

^* To whom correspondence should be addressed. E-mail: metz{at}neurochem.u-strasbg.fr.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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), Simplified Acute Physiologic Score II (SAPS II) (r² = 0.438; P < 0.001), and the Logistic Organ Dysfunction System (LODS) score (r² = 0.374; P < 0.001). Nonsurvivors had significantly higher CGA and PCT concentrations than survivors [median (interquartile range): 293.0 µg/L (163.5–699.5 µg/L) vs 86.0 µg/L (53.8–175.3 µg/L) for CGA, and 6.78 µg/L (2.39–22.92 µg/L) vs 0.54 µg/L (0.16–6.28 µg/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 (r² = 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).

CONCLUSIONS: CGA is a strong and independent indicator of prognosis in critically ill nonsurgical patients.