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

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. © 2009 Informa UK Ltd.