Association of hemochromatosis with infectious diseases: expanding spectrum

Khan, Fida A.; Fisher, Melanie; Khakoo, Rashida

doi:10.1016/j.ijid.2007.04.007

Cited by 181 publications

(155 citation statements)

References 69 publications

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“…21,22 With regard to HCT, Pullarkat et al 16 reported that ferritin levels of X1000 ng/ mL were associated with a 2-fold higher risk of bloodstream infection compared with patients with ferritin levels of o1000 ng/mL in myeloablative HCT. In agreement with their finding, in this study, ferritin levels of 4700 ng/mL were associated with a 4-fold increased risk compared with the risk in patients with levels of p700 ng/mL.…”

Section: Discussionmentioning

confidence: 99%

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Kanda

Mizumoto

Ichinohe

et al. 2010

Bone Marrow Transplant

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Although fluoroquinolones or other antibiotics are commonly used to prevent bacterial infections after hematopoietic cell transplantation (HCT), because of the growing presence of multidrug-resistant microorganisms, it is important to identify patients who are more likely to benefit from antibacterial prophylaxis. To evaluate risk factors for early bacterial infection after allogeneic HCT, we retrospectively analyzed clinical data for 112 consecutive adult patients with hematological malignancies who received transplants without any antibacterial prophylaxis. The cumulative incidence of bacterial infection at 30 days after transplantation was 16%. Among various pre-transplant factors, only high serum ferritin (4700 ng/mL, 47 patients) and high C-reactive protein (CRP) (40.3 mg/dL, 28 patients) levels were significantly associated with the development of bacterial infection in a multivariate analysis (hazard ratio (95% confidence interval): ferritin, 4.00 (1.32-12.17); CRP, 3.64 (1.44-9.20)). In addition, septic shock and sepsis with organ failure were exclusively observed in patients who had high ferritin and/or high CRP levels. These results suggest that pretransplant serum ferritin and CRP levels can be useful markers for predicting the risk of early bacterial infection after allogeneic HCT. It may be prudent to limit antibacterial prophylaxis to patients with predefined risk factors to ensure the safety of HCT with the use of fewer antibiotics.

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Section: Discussionmentioning

confidence: 99%

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Kanda

Mizumoto

Ichinohe

et al. 2010

Bone Marrow Transplant

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“…The median LOS was 7 days (5-12), which was not significantly different between the groups that received (7 days [4][5][6][7][8][9][10][11]) and did not receive intravenous iron (7 days [5][6][7][8][9][10][11][12]; P=0.29). There were 3220 patients (14.1% of the cohort) who were readmitted for infection or died from any cause within 30 days of discharge.…”

Section: Associations Of Intravenous Iron With Adverse Outcomesmentioning

confidence: 99%

“…Intravenous iron is an important part of the optimal treatment of anemia of ESRD (1), but it is biologically plausible that iron may increase infection risk by impairing neutrophil (2,3) and T cell function (4) and serving as a growth factor for pathogens (4,5). Although an association between iron and viral and fungal infections has been described (5,6), the literature in hemodialysis patients has pertained largely to bacterial infections, with a particular emphasis on systemic infections (e.g., bacteremia) (7).…”

Section: Introductionmentioning

confidence: 99%

“…Although an association between iron and viral and fungal infections has been described (5,6), the literature in hemodialysis patients has pertained largely to bacterial infections, with a particular emphasis on systemic infections (e.g., bacteremia) (7). Results from studies evaluating the association between intravenous iron and bacterial infection in hemodialysis patients have been conflicting, and prior studies have had limitations such as the use of serum ferritin as a predictor, lack of control for confounding and residual confounding, small sample size, short follow-up time, and publication bias (7).…”

Section: Introductionmentioning

confidence: 99%

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Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection

Ishida

Marafino

McCulloch

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection.Design, setting, participants, & measurements This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated.Results There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78-271 days). The median length of stay was 7 days (25th and 75th percentiles, 5-12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron.Conclusions This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations.

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“…4 The level of iron overload in thalassemia patients makes them more vulnerable to TB infection. 5 With current, better quality therapy, thalassemia patients can live longer, hence, the probability of exposure to TB infection is increased. 6 However, only 5-10% of people who are infected by Mycobacterium tuberculosis (MTB) will develop active TB disease.…”

mentioning

confidence: 99%

Natural resistance-associated macrophage protein 1 gene polymorphisms in thalassemia patients with tuberculosis infection

Ghozali

Dewi

Ghrahani

et al. 2016

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Association of hemochromatosis with infectious diseases: expanding spectrum

Cited by 181 publications

References 69 publications

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection

Natural resistance-associated macrophage protein 1 gene polymorphisms in thalassemia patients with tuberculosis infection

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