Ferritin is associated with the severity of lung involvement but not with worse prognosis in patients with COVID-19: data from two Italian COVID-19 units

Abstract

The coronavirus 2019 disease (COVID-19) is characterised by a heterogeneous clinical presentation, a complex pathophysiology and a wide range of imaging findings, depending on disease severity and time course. We conducted a retrospective evaluation of hospitalized patients with proven SARS-CoV-2 infection, clinical signs of COVID-19 and computed tomography (CT) scan-proven pulmonary involvement, in order to identify relationships between clinical, serological, imaging data and disease outcomes in patients with COVID-19. Clinical and serological records of patients admitted to two COVID-19 Units of the Abruzzo region in Italy with proven SARS-CoV-2 pulmonary involvement investigated with CT scan, assessed at the time of admission to the hospital, were retrospectively evaluated. Sixty-one patients (22 females and 39 males) of median age 65 years were enrolled. Fifty-six patients were discharged while death occurred in 5 patients. None of the lung abnormalities detected by CT was different between discharged and deceased patients. No differences were observed in the features and extent of pulmonary involvement according to age and gender. Logistic regression analysis with age and gender as covariates demonstrated that ferritin levels over the 25th percentile were associated with the involvement of all 5 pulmonary lobes (OR = 14.5, 95% CI 2.3–90.9, p = 0.004), the presence of septal thickening (OR = 8.2, 95% CI 1.6–40.9, p = 0.011) and the presence of mediastinal lymph node enlargement (OR = 12.0, 95% CI 1.1–127.5, p = 0.039) independently of age and gender. We demonstrated that ferritin levels over the 25th percentile are associated with a more severe pulmonary involvement, independently of age and gender and not associated with disease outcomes. The identification of reliable biomarkers in patients with COVID-19 may help guiding clinical decision, tailoring therapeutic approaches and ultimately improving the care and prognosis of patients with this disease.

Immuno-proteomic profiling reveals abundant airway CD8 T cells and ongoing epithelial injury in prolonged post-COVID19 respiratory disease

“…The airway monocyte frequency is, however, one of the few features to correlate with a clinical biomarker of severity in acute disease, serum ferritin. High serum ferritin is a prognostic marker used at presentation with acute COVID19 and linked to more severe acute radiological findings (Carubbi et al, 2021;Ruan et al, 2020). Ferritin, and transferrin, the protein responsible for transporting ferritin, are core components of iron metabolism, and their dysregulation is associated with a range of lung pathologies including decreased lung function and lung fibrosis (Ali et al, 2020;Lee et al, 2020).…”

Compassionate mesenchymal stem cell treatment in a severe COVID-19 patient: a case report

“…In this case, after MSC administration we observed a reduction in leukocyte count, D-dimer levels, and CRP-levels, all of which are prognostic factors for COVID-19 severity ( 20 - 23 ) ( Table 2 , Figure 2 ). The D-dimer reduction was particularly impressive.…”

International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study

“…We then compared standardized mean laboratory test values stratified by disease severity at days 0, 1, and 7 to investigate changes in laboratory trajectories between the 2 waves. We focused on the following 6 blood laboratory values associated with worse outcomes and severe disease in patients with COVID-19: C-reactive protein (CRP), ferritin, fibrinogen, procalcitonin, D-dimer, and creatinine [21][22][23][24][25][26][27][28]. To facilitate effective comparisons, we defined standardized laboratory values as relative to each laboratory test's harmonized value on the index date in the first wave.…”