嗜铬粒蛋白A对危重病人预后的评估作用：一个ICU中的队列研究
张丹1
重庆医科大学附属第一医院急诊科中心ICU
Abstract
Background : Risk assessment of patients should be based on objective variables that can be routinely measured, like biological markers. Acute response to stress results in release of catecholamines from the adrenal medulla, together with chromogranin A (CGA). To date no study has yet been carried out to evaluate the prognostic value of CGA in patients of intensive care units.
Methods: We conducted a prospective study in such patients to measure serum procalcitonin (PCT), C-reactive protein (CRP) and CGA obtained at admission. Univariate and multivariate analyses were performed to identify the ability of these biomarkers to predict mortality.
Results: In 120 consecutive patients a positive correlation was found between CGA and CRP (r²=0.216, p=0.02) and PCT (r²=0.396, p<0.001) and Simplified Acute Physiologic Score II (SAPS II) (r²=0.438, p<0.001) and Logistic Organ Dysfunction System (LODS) (r²=0.374, p<0.001). Non survivors had significantly higher CGA and PCT values than survivors (median (interquartile range) of 293.0 ng/mL (163.5–699.5) versus 86.0 ng/mL (53.8–175.3) for CGA, and 6.78 ng/mL (2.39–22.92) versus 0.54 ng/mL (0.16–6.28) for PCT, p<0.001). In multivariable linear regression analysis, creatinine (p<0.001), age (p<0.001) and SAPS II (p=0.002) were the only independent variables predicting CGA levels (r²=0.352). In multivariate analysis, 3 independent factors were involved in death prediction: log-normalized CGA levels (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 non surgical critically ill patients.
