Ferritin thresholds for cardiac and liver hemosiderosis in β-thalassemia patients: a diagnostic accuracy study

Darvishi‐Khezri, Hadi; Aliasgharian, Aily; Naderisorki, Mohammad; Kosaryan, Mehrnoush; Ghazaiean, Mobin; Fallah, Hanie; Zahedi, Mohammad Javad; Karami, Hossein

doi:10.1038/s41598-022-22234-9

Cited by 2 publications

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References 34 publications

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“…Studies have consistently shown that higher ferritin levels correlate with hepatic iron concentration and are predictive of hepatic complications in thalassemia major. [ 5 6 ] Elevated serum aminotransferases, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), indicate hepatocellular injury, while declining albumin may reflect synthetic dysfunction in advanced liver disease. [ 7 ] Several researchers have reported derangements in liver enzymes and synthetic function in transfused thalassemia patients.…”

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confidence: 99%

Association of serum ferritin trends with liver enzyme patterns in β-thalassemia major: A longitudinal correlational study

Rabadiya,

Yogesh,

Nagda

et al. 2024

Journal of Family Medicine and Primary Care

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Background: β-Thalassemia major patients require lifelong blood transfusions, leading to iron overload and liver injury. This study examines the longitudinal association between serum ferritin and liver function over 5 years in pediatric patients. Methods: This retrospective study included 582 transfusion-dependent thalassemia patients aged 1–18 years. Serum ferritin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and albumin were measured annually. Correlation and linear regression analyses assessed associations between ferritin trajectories and liver enzymes. Results: Mean ferritin rose from 1820 ± 960 ng/mL at baseline to 4500 ± 1900 ng/mL at year 5, indicating worsening iron overload. AST and ALT levels also steadily climbed over follow-up, whereas albumin declined slightly. Ferritin correlated positively with AST (r = 0.675, P < 0.01) and ALT (r = 0.607, P < 0.01), but not with albumin (r = -0.143, P = 0.153) annually. The regression interaction term showed within-patient ferritin increases over time were independently associated with escalating AST and ALT (P < 0.05), after adjusting for confounders. Conclusion: Rising ferritin levels predict progressive liver injury in regularly transfused pediatric thalassemia patients. Tighter control of iron overload may help preserve hepatic function.

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Section: Introductionmentioning

confidence: 99%

Association of serum ferritin trends with liver enzyme patterns in β-thalassemia major: A longitudinal correlational study

Rabadiya,

Yogesh,

Nagda

et al. 2024

Journal of Family Medicine and Primary Care

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“… 3 – 7 Most hematological societies recommend a serum ferritin (SF) level greater than 1000 ng/mL as an indication for initiation of iron chelation therapy in TDT patients. 3 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Optimized serum ferritin prediction of iron overload in transfusion-dependent thalassemia: likelihood ratio and age-adjustment approach

Kurban

Almarri²,

Alshamsi³

et al. 2023

Ann Saudi Med

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BACKGROUND: Early detection of iron overload in transfusion-dependent thalassemia (TDT) patients is critical to prevent complications and improve survival. OBJECTIVES: Evaluate the utility of serum ferritin (SF) in the prediction of hepatic and myocardial iron overload (HIO and MIO) compared to T2*-MRI. DESIGN: Retrospective SETTINGS: Governmental hospitals. PATIENTS AND METHODS: Patients with TDT who had T2*-MRI examinations between January 2016 to October 2019 were included. The predictive value of SF for detection of HIO and MIO was assessed by measuring area under the curve (AUC). A sample size of 123 cases was calculated to detect a correlation of 0.25 with 90% power and a two-sided type I error of 0.05. MAIN OUTCOME MEASURES: The correlation between SF and estimated hepatic iron concentration. SAMPLE SIZE: 137 TDT patients who required regular blood transfusions. RESULTS: The predictive value of SF was excellent for detection of HIO (AUC=0.83-0.87) but fair for detection of MIO (AUC=0.67). The two independent predictors of MIO were age and SF. The log of (age × SF) enhanced the SF predictive value for MIO (AUC=0.78). SF values of 700 and 1250 mg/L effectively excluded mild and moderate HIO with a sensitivity of 97.8% and 94.2%, respectively (LR−=0.1). While SF values of 1640 and 2150 mg/L accurately diagnosed mild and moderate HIO with a specificity of 95.55% and 96.4%, respectively (LR+>10). A log of (age × SF) cut-off value of 4.15 effectively excluded MIO (LR−=0.1), while a value of 4.65 moderately confirmed MIO (LR+=3.2). CONCLUSIONS: SF is an excellent predictor of hepatic IO in TDT. Age adjustment enhanced its myocardial IO predictive accuracy. Likelihood ratio-based SF cut-off values may help clinicians in risk stratification and treatment decision-making. LIMITATIONS: The laboratory data were gathered retrospectively and although the risk of selection bias for T2*-MRI examination is thought to be low, it cannot be ignored. CONFLICT OF INTEREST: None.

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Ferritin thresholds for cardiac and liver hemosiderosis in β-thalassemia patients: a diagnostic accuracy study

Cited by 2 publications

References 34 publications

Association of serum ferritin trends with liver enzyme patterns in β-thalassemia major: A longitudinal correlational study

Association of serum ferritin trends with liver enzyme patterns in β-thalassemia major: A longitudinal correlational study

Optimized serum ferritin prediction of iron overload in transfusion-dependent thalassemia: likelihood ratio and age-adjustment approach

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