Effect of Serum Ferritin on the Prognosis of Patients with Sepsis: Data from the MIMIC-IV Database

Abstract

Background. The present study aimed to investigate the prognostic value of serum ferritin in critically ill patients with sepsis by using the MIMIC-IV database. Methods. Data were extracted from the MIMIC-IV database. Adult patients who met the sepsis-3 criteria and had the test of ferritin were included. Patients were divided into subgroups according to the initial serum ferritin. The association between initial serum ferritin and in-hospital mortality was performed by using Lowessregression, logistic regression, and ROC analysis. Subgroup analysis was used to search for the interacting factors and verify the robustness of the results. Results. Analysis of the 2,451 patients revealed a positive linear relationship between serum ferritin and in-hospital mortality. Patients with high-ferritin had a higher risk of in-hospital mortality, but no significant association was found in the low-ferritin subgroup compared with those whose ferritin was in the normal reference range. Serum ferritin had moderate predictive power for in-hospital mortality (AUC = 0.651), with an optimal cut-off value of 591.5 ng/ml. Ferritin ≥591.5 ng/ml acted as an independent prognostic predictor of in-hospital mortality, which increased the risk of in-hospital mortality by 119%. Our findings were still robust in subgroup analysis, and acute kidney injury and anemia were considered interactive factors. Conclusion. High-level serum ferritin was an independent prognostic marker for the prediction of mortality in patients with sepsis. Further high-quality research is needed to confirm the relationship between ferritin and the prognosis of septic patients.

Immune profile of patients‑a new approach in management of sepsis and septic shock?

“…When the patients we compared according to the ferritin threshold of 500 µg/l, ferritin levels were significantly higher in patients with septic shock and in non-survivors, similar to the results of one study (50). According to the results of one study, high-level serum ferritin is an independent prognostic marker for the prediction of mortality in patients with sepsis (51).…”

Association between ferritin to albumin ratio and 28-day mortality in patients with sepsis: a retrospective cohort study

“…Our research findings strongly support the close association between elevated serum ferritin levels and poor prognosis in sepsis patients, consistent with the study conducted by Liudang He et al [ 6 ]. In addition, the study by Yi-Peng Fang et al [ 26 ] revealed a significant correlation between high serum ferritin levels and increased in-hospital mortality rate in sepsis patients, establishing it as an independent prognostic indicator for predicting mortality in septic patients. However, it is important to consider that factors, such as inflammation, liver and kidney function, as well as dietary and nutritional status, can also influence serum ferritin levels.…”

A Comprehensive Review on Serum Ferritin as a Prognostic Marker in Intensive Care Units: Insights Into Ischemic Heart Disease

“…Regular monitoring of serum ferritin levels in critically ill patients, especially those afflicted with sepsis or multiple organ dysfunction syndrome (MODS), offers valuable insights into disease severity and prognosis [ 24 , 38 ]. Utilizing ferritin as a prognostic biomarker necessitates the establishment of optimal cut-off values to predict outcomes such as mortality, organ failure, and the necessity for mechanical ventilation, thereby facilitating risk assessment and informing clinical decision-making processes [ 26 , 38 ]. Moreover, the association between elevated serum ferritin levels and adverse outcomes in sepsis and critical illness underscores the imperative for targeted interventions to modulate iron metabolism and mitigate inflammatory responses [ 26 , 39 ].…”

“…A comprehensive understanding of the relationship between serum ferritin dynamics and clinical outcomes, including mortality rates, organ failure occurrences, and duration of ICU stays, is pivotal in predicting patient trajectories and optimizing treatment plans [ 23 , 24 ]. Future research endeavors should focus on conducting large-scale prospective studies to validate the prognostic value of serum ferritin in critically ill patients, specifically emphasizing its relevance in conditions like sepsis, MODS, and other critical illnesses [ 38 , 39 ]. Exploring the underlying mechanisms linking elevated serum ferritin levels to adverse outcomes holds promise in identifying potential therapeutic targets and devising novel treatment strategies to enhance patient outcomes in ICU settings [ 26 , 39 ].…”