High serum ferritin is associated with worse outcome of patients with decompensated cirrhosis

Abstract

BackgroundStudies in patients with decompensated cirrhosis showed a correlation between serum ferritin levels and patients’ prognosis. Besides, red blood cell distribution width (RDW) and mean platelet volume (MPV) have been associated with the severity of hepatic function. The aim of this study was to evaluate the prognostic impact of serum ferritin and RDW/MPV in the outcome [survival, death, or liver transplantation (LT)] of patients with stable decompensated cirrhosis.MethodsConsecutive adult patients with stable decompensated cirrhosis admitted to our department between September 2010 and February 2016 were included. Serum ferritin, RDW and MPV were recorded in every patient. They were followed up and their outcome (alive, death, or LT) was evaluated.Results192 consecutive patients with stable decompensated cirrhosis (142 men, age 54.2±12 years); at the end of follow up [12 (range: 1-64) months] 62 patients remained alive and 130 died or underwent LT. In multivariate analysis, serum ferritin (HR 1.001, 95%CI 1.00-1.002, P=0.005) and GFR (HR 0.96, 95%CI 0.92-0.99, P=0.035) were the only independent factors significantly associated with the outcome. Ferritin had low discriminative ability (AUC: 0.61) to the outcome yielding a sensitivity and specificity of 85.3% and 44.2%, respectively, at the best cut-off point (>55 ng/mL), while patients with ferritin >55 ng/mL (n=145) had a worse outcome compared to those with ferritin ≤55 ng/mL (n=47) (log rank P=0.001). RDW and MPV were not associated with the outcome.ConclusionHigh serum ferritin, but not RDW/MPV, is associated with worse outcome in patients with established decompensated cirrhosis. However, further studies are needed to elucidate better this issue.

Serum iron parameters in liver cirrhosis

“…It is in line with research conducted by Olmes et al and Büyükaşik et al [3,13] Oikonomou et al showed that the best cut-off point for the outcome was ferritin >55 ng/ml with sensitivity 85.3% and specificity 11.2% and patients with ferritin > 55 had aworse outcome, compared to those with ferritin ≤ 55 ng/ml. [8] In this study, there was an increase in ferritin levels along with worsening of disease characterized by an increase in the Child-Pugh class.…”

“…Their lines of evidence suggest that iron may be an important co-factor in the progression of liver cirrhosis. [8] Ferritin synthesis is induced by macrophages, and hepatocytes and raised levels can be seen either in iron overload conditions or several pathologies, inflammation, infection and liver diseases. [9] Walker et al showed that serum ferritin could be an independent predictor of mortality in cirrhosis patients awaiting LT and high levels associated with the higher frequency of liver-related complications.…”

“…Finally, it might reflect an iron overload condition resulting in significant morbidity and early mortality. [8] Examination of iron parameters especially ferritin is a simple and inexpensive examination, but so it can be used to find out iron homeostasis that can predict the occurrence of complications and determine the prognosis of patients with cirrhosis hepatic so that precautions can be an option so that no further life-threatening complications.…”

Review article: iron disturbances in chronic liver diseases other than haemochromatosis – pathogenic, prognostic, and therapeutic implications

“…The similarity of the findings across a broad spectrum of different chronic liver diseases and resolution of the abnormalities during treatment suggest that the disturbances are consequences of liver injury . Alternatively, the association of the iron disturbances with disease severity and the recognised hepatotoxicity of iron overload compel consideration of iron as a pathogenic factor.…”

“…Hyperferritinemia is also an important prognostic marker that has been associated with dire outcomes in advanced chronic liver disease, and it may have a nefarious role in some forms of liver disease that counters its anti‐oxidant and cytoprotective actions. Ferritin can promote Fas‐mediated apoptosis, activate hepatic stellate cells (HSCs), increase hepatic fibrosis, and behave as a pro‐inflammatory cytokine (Table ) .…”