Association of serum ferritin with COVID-19 in a cross-sectional study of 200 intensive care unit patients in a rural hospital

Abstract

Background: The COVID-19 disease caused by the SARS-CoV-2 virus, has toppled the world since first case noted in 2019, and the cases have been increasing there after. This grave effect is caused by the cytokine storm induced inflammation produced by the noxious virus. As it is an inflammatory state, various acute phase reactants are expected to raise; thus serum ferritin is contemplated to increase. Here we aim to anchor serum ferritin as a way marker for diagnosis and management of COVID-19 patients and study its role as a prognostic marker. Another aspect is the association of COVID-19 with the N: L ratio; observation has stated that higher N: L ratio results in more severe outcome. The study aimed to establish a correlation of COVID-19 severity with serum ferritin in the form of HRCT Score, N: L Ratio and Clinical Outcome in the patients admitted in Intensive Care Unit Result: Out of 200 patients who were admitted in the intensive care unit with COVID-19, the association of serum ferritin with N: L Ratio and HRCT Score was significant, and the association of serum ferritin with clinical outcome in terms of discharged and expired was found to be statistically significant Conclusion: Serum ferritin was found to be a potent marker for clinical outcome in intensive care unit patients in terms of death versus treated. HRCT Score and N:L ratio were found to be correlated with serum ferritin. Therefore, we conclude that serum ferritin may determine the severity of COVID-19 infection and it can be used as a marker for Clinical Outcome thereby making it an often neglected biomarker for predicting prognosis in COVID-19 with most of the physicians focusing mostly on interleukin 6, C Reactive protein and d dimer as a marker of severe COVID infection.

A study on diagnostic and prognostic significance of laboratory parameters and its correlation with HRCT of lung in Covid-19 patients

“…Patients with raised LDH in mild CT score were 21 out of 27 (77.77%), in moderate CT score (11)(12)(13)(14)(15) were 27 out of 27(100%), in severe CT score (16)(17)(18)(19)(20) were 34 out of 34 (100%), in very severe CT scores were 9 out of 12(75%). HRCT Score and LDH showed positive correlation (r-0.26).…”

“…Various authors also studied these and reported similar findings. They are Padiya G S et al, 11 Kömürcüoglu B et al, 12 Sharma S. et al, 3 Vidyashree S et al, 13 Gupta P et al, 14 Padiya G S et al 11 did a study on 59 patients which included 21 patients in the mild group,31 in the moderate group, and 7 in the severe group. CT severity score was found to be positively correlated with ferritin levels (p < 0.001).…”

Considering the inter-assay harmonization status of ferritin measurements when using serum ferritin for research on COVID-19

“…I read with great interest the study by Hulkoti and colleagues reporting that a high concentration of serum ferritin was a prognostic marker in severe coronavirus disease (COVID-19). [ 1 ] As they stated,[ 1 ] ferritin has tended to be a forgotten marker among markers relevant to clinical decision-making concerning COVID-19; therefore, their finding of ferritin is unique. As measuring ferritin is readily performed and relatively inexpensive, their idea of including ferritin in clinical practice for COVID-19 cases[ 1 ] also appears quite useful.…”

“…[ 1 ] As they stated,[ 1 ] ferritin has tended to be a forgotten marker among markers relevant to clinical decision-making concerning COVID-19; therefore, their finding of ferritin is unique. As measuring ferritin is readily performed and relatively inexpensive, their idea of including ferritin in clinical practice for COVID-19 cases[ 1 ] also appears quite useful. Further studies should be conducted to determine the correlation of ferritin levels with the severity and cut-off levels of ferritin for identifying the likelihood of critical outcomes in patients with COVID-19.…”

“…We await further advances in research using ferritin to improve clinical practice for COVID-19 following the Hulkoti study. [ 1 ]…”