61The third piece of information available is that a single VS-I plasma concentra-
tion evaluation on admission can affect the assessment of 28-day outcome within
5 h after admission (time required for the performance of the test). We have gath-
ered three data suggesting that patients who present increased plasma VS-I concen-
trations on admission have a higher risk of death within 28 days: first, patients that
die have on average higher VS-I concentrations on admission, whatever the disease
on admission; second, death rates are significantly higher when patients have an
admission VS-I level beyond a median value of 3.97 ng/ml; third, the VS-I concen-
tration in plasma is an independent risk factor for survival. Why the increased VS-I
circulating concentration is an ominous sign remains to be determined since protec-
tive effects have been reported in animals (Roatta et al. 2011 ); one possible explana-
tion is that protective effects (at high concentrations) are related to intracellular
concentrations of VS-I and not circulating ones.
Lactate has often been considered as the best biomarker of severity early after
onset of a severe disease and has therefore gained considerable acceptance (Trzeciak
et al. 2007 ). Finally, using a combination of VS-I, lactate and age values, which are
all available early after admission, our assessment of prognosis was better than tak-
ing the parameters alone (Schneider et al. 2012 ). Our findings enable us to hope for
better routine decision-making for critically ill patients and also to improve
emergency triage in patients who display increased lactate levels without obvious
clinical signs of severity.
Patients
Healthy controls20151050
0 h 12 h 24 h36 h4 8 h60 hVS-Iconcentration (ng/mL)p <0.01, Anova∗
∗
Fig. 6 Serial twice-a-day VS-I sampling in patients with simultaneous SIRS and acute circulatory
failure criteria (Schneider et al. 2012 )
Involvement of Chromogranin A and Its Derived Peptides to Fight Infections