Is proton pump inhibitor use a significant confounder for chromogranin A levels in sepsis? Reply to Haranath and Jakkinaboina

Abstract

Dear Editor, In their letter Drs. Haranath and Jakkinaboina make some comments relevant to our recently published article ‘‘Prognostic value of chromogranin A in severe sepsis: data from the FINNSEPSIS study’’ [1]. Regrettably, we have inverted the data for hospital survivors and non-survivors concerning use of proton pump inhibitor (PPI) in Table 1, and a correction has been posted. This has no effect on the results of the study and there are no other errors in the table. The FINNSEPSIS study is one of the largest severe sepsis cohorts with serial blood sampling currently assembled and a strength of the study is the unbiased inclusion of patients. Hence, we did not exclude patients on the basis of prior medical history or the use of medication. We lack information on patients with previous neuroendocrine tumors, but considering a prevalence of 35/100,000 for all neuroendocrine tumors [2] it is unlikely that a high number of patients with neuroendocrine tumors were included in our cohort of patients with severe sepsis. Moreover, we report hospital mortality as our primary endpoint and this was sepsis-related in all patients. Finally, there are comments relating to the use of PPI and chromogranin A (CgA) measurements. Information regarding previous use of PPI was not collected in FINNSEPSIS, but we report the prevalence of PPI use during the hospitalization for severe sepsis in our patients. PPI use clearly influences CgA levels, also after short-term use [3], but given the prevalent use of PPI as a protective measure against stressinduced ventricular ulcers in patients with severe sepsis (84 % overall in our cohort), it would clearly not be of clinical interest to only report data for patients not treated with PPIs.