Ferritin and C-reactive protein are predictive biomarkers of mortality and macrophage activation syndrome in adult onset Still’s disease. Analysis of the multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort

Benedetto, Paola Di; Cipriani, Paola; Iacono, Daniela; Pantano, Ilenia; Caso, Francesco; Emmi, Giacomo; Grembiale, Rosa Daniela; Cantatore, Francesco Paolo; Atzeni, Fabiola; Perosa, Federico; Scarpa, Raffaele; Guggino, Giuliana; Ciccia, Francesco; Giacomelli, Roberto; Ruscitti, Piero

doi:10.1371/journal.pone.0235326

Cited by 36 publications

(20 citation statements)

References 55 publications

(76 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study revealed a higher median body temperature, more frequent presence of hepato-and splenomegaly, severe hyperferritinemia, hypofibrinogenemia, and pancytopenia, i.e., anaemia, leukopenia, and lymphocytopenia and higher D-dimers in patients with MAS. This agrees with findings in MAS resulting from other causes, mostly from rheumatoid diseases [32][33][34]. As it might be difficult to differentiate MAS from sepsis, especially if the viral infection is a trigger for MAS, it is essential to determine procalcitonin and ferritin levels to distinguish patients with MAS from ones with sepsis.…”

Section: Discussionsupporting

confidence: 86%

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Oliynyk

Barg

Ślifirczyk

et al. 2021

Viruses

View full text Add to dashboard Cite

Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0–4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25–0.99). Сonclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.

show abstract

Section: Discussionsupporting

confidence: 86%

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Oliynyk

Barg

Ślifirczyk

et al. 2021

Viruses

View full text Add to dashboard Cite

show abstract

“…anaemia, leukopenia, and lymphocytopenia and higher D-dimers in patients with MAS. This agrees with findings in MAS resulting from other causes, mostly from rheumatoid diseases [29][30][31]. As it might be difficult to differentiate MAS from sepsis, especially if the viral infection is a trigger for MAS, it is essential to determine procalcitonin and ferritin levels to distinguish patients with MAS from ones with sepsis.…”

Section: Discussionsupporting

confidence: 86%

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome.

Oliynyk

Barg

Ślifirczyk

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In each group, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/ml, p &lt;0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p=0.043), RR = 2.1 (95% CI 1.0-4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p=0.013), RR = 0.50 (95% CI 0.25-0.99). Сonclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients it contributed to reduced mortality.

show abstract

“…Any predictive factors for mortality were not specified [7]. In a study evaluating patients with AOSD, no correlation was found between ferritin level and mortality, while CRP levels were found as a parameter predicting mortality [17]. In our study, 8.6% of the whole-study group died within 3 months.…”

Section: Discussioncontrasting

confidence: 64%

Evaluation of hyperferritinemia causes in rheumatology practice: a retrospective, single-center experience

Teke

Cansu²,

Korkmaz

2021

Rheumatol Int

View full text Add to dashboard Cite

Hyperferritinemia may develop due to various reasons such as inflammation, infection, or malignancy. The purpose of the study to explore the prevalence and to figure out the causes of general hyperferritinemia and extreme hyperferritinemia as detected through the ferritin measurements requested by the rheumatology department. Adult patients at the age of 18 years and older with at least one serum ferritin level measurement at or above 500 ng/mL as requested by the rheumatology department between January 2010 and December 2019 were evaluated retrospectively. Hyperferritinemia was detected in 4.7% of 11,498 serum ferritin tests. The mean age of 242 patients found to have hyperferritinemia was 53.7 ± 17.1 years; of the patients, 63.2% were female, and the mean serum ferritin value was 2820 ± 5080 ng/mL. The most common cause of hyperferritinemia was rheumatological diseases with a ratio of 59.1%, which was followed by infections, iron overload, and solid malignancy. Among the rheumatologic diseases, adult-onset Still's disease (AOSD), rheumatoid arthritis, and vasculitis were the cause accounting for hyperferritinemia. Ferritin levels were significantly higher in the AOSD group compared to the other rheumatologic disease groups (p < 0.0001). While extreme hyperferritinemia (ferritin ≥ 10,000 ng/mL) rate in our cohort was 0.2%, the most common cause was AOSD (15/17). In patients with hyperferritinemia, 3 month mortality was found to be 8.7%. CRP level was identified as the only independent predictor for the 3 month mortality in all patients [OR 1.088 (95% CI 1.004-1.178), p = 0.039]. Although rheumatologic disease activation and infections are the most common causes, the other causes should also be considered for the differential diagnosis.

show abstract

Ferritin and C-reactive protein are predictive biomarkers of mortality and macrophage activation syndrome in adult onset Still’s disease. Analysis of the multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort

Cited by 36 publications

References 55 publications

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome.

Evaluation of hyperferritinemia causes in rheumatology practice: a retrospective, single-center experience

Contact Info

Product

Resources

About