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Plasma chromogranin A after severe burn trauma
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemical endocrinology.
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2013 (English)In: Neuropeptides, ISSN 0143-4179, E-ISSN 1532-2785, Vol. 47, no 3, 207-212 p.Article in journal (Refereed) Published
Abstract [en]


Chromogranin A (CgA) in plasma (P-CgA), a neuroendocrine marker of sympathetic stress, has been shown to predict mortality in medical intensive care. We hypothesized that the magnitude of CgA release would reflect stress load, and thereby injury severity in burn intensive care patients.


Fifty-one consecutive patients with a burn area exceeding 10% were included. P-CgA was measured twice daily for seven days after injury. The point value at 24h, the mean and maximum values and the AUC at days 1-7, were tested as possible predictors. Injury severity in the form of organ dysfunction was measured as SOFA score at day 7.


P-CgA could be classified into two types with respect to variability over time. Patients with high variability had more deep injuries and were older than those with low variability. All measures of CgA correlated with SOFA score at day 7, but not with total burn size. Univariate regressions showed that age, burn size and three of four measures of P-CgA predicted organ dysfunction. Multiple regressions showed that age, burn size, and either P-CgA at 24h, the mean value up to day 7, or the maximum value up to day 7, were independent predictors for organ dysfunction. Significant organ dysfunction was best predicted by age, burn area and the CgA point value at 24h with an AUC value of 0.91 in a ROC-analysis.


The extent of neuroendocrine activation assessed as P-CgA after a major burn injury is independently related to organ dysfunction.

Place, publisher, year, edition, pages
2013. Vol. 47, no 3, 207-212 p.
National Category
Clinical Medicine
URN: urn:nbn:se:uu:diva-188785DOI: 10.1016/j.npep.2012.10.004ISI: 000320751200010PubMedID: 23206950OAI: oai:DiVA.org:uu-188785DiVA: diva2:579190
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2015-02-27
In thesis
1. Neuroendocrine Stress Response after Burn Trauma
Open this publication in new window or tab >>Neuroendocrine Stress Response after Burn Trauma
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Some aspects of the stress response during acute intensive care for severe burns are described and quantified by measuring hormonal and neuroendocrine patterns and relating these to organ function in the short term. This includes an assessment of whether there are markers for the severity of stress that are better than conventional descriptors of the severity of a burn in predicting failing organ function.

P-CgA after a major burn injury is an independent and better predictor of organ dysfunction assessed as SOFA score than the traditionally used TBSA% burned. The results also suggest that the extent of neuroendocrine activation is related to organ dysfunction, and this motivates a more extensive effort to evaluate P-CgA as a prognostic marker with respect to mortality and long-term outcome.

P-NT-proBNP exhibited a complex pattern with considerable inter-individual and day-to-day variations. Values of P-NT-proBNP were related to size of burn, water accumulation and systemic inflammatory response. A considerable covariation with trauma response and SOFA scores was observed in day by day analyses, but with weight change only on day 2.

Maximum P-NT-proBNP showed a stronger correlation with SOFA score on day 14, with mortality, and with LOS, than did age and TBSA% burned. High values were also independent predictors of all subsequent SOFA scores up to two weeks after injury.

P-NT-proBNP and NT-proANP reflect and predict organ function after burn injury similarly, notwithstanding a significantly larger intra-individual variability for P-NT-proBNP. P-NT-proBNP, but not NT-proANP, reflects the systemic inflammatory trauma response.

Free cortisol concentration was related to the size of burns, as was the circadian cortisol rhythm. This effect of burn size was, at least in part, related to its effect on organ function.

This thesis points to the fact that the stress response is richly interwoven, and cannot be adequately assessed by one biomarker only. All biomarkers studied here can be viewed as representing efferent limbs of the stress reaction, and they would need to be supplemented by biomarkers representing individual physiologic responses that follow the stress signaling.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 908
Burn, Injuries, Neuroendocrine, Intensive Care, Cortisol, Chromogranin A, Natriuretic peptides
National Category
Research subject
Plastic Surgery
urn:nbn:se:uu:diva-198466 (URN)978-91-554-8686-0 (ISBN)
Public defence
2013-06-14, Skoogsalen, Entrance 78-79, Akademiska Sjukhuset, Uppsala, 09:15 (Swedish)
Available from: 2013-05-24 Created: 2013-04-15 Last updated: 2013-08-30

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Lindahl, Andreas ELow, AiliStridsberg, MatsEkselius, LisaGerdin, Bengt
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