CALCA and Sepsis: CRBSI can cause SIRS and even lead to septic shock.[13] Pro-ADM, as a calcitonin gene-related peptide, is generally upregulated during SIRS or sepsis because bacterial endotoxins and pro-inflammatory cytokines upregulate the ADM gene.[14] Therefore, the increased level of serum pro-ADM in our CRBSI subjects may be explained in part by ADM gene upregulation associated with CRBSI.