Hyperferritinemia in the elderly can differentiate the bad from the worst

Goldhaber, Gal; Segal, Gad; Dagan, Amir

doi:10.1097/md.0000000000021419

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…Of interest, however, when stratifying patients according to the levels of ferritin, the association between higher ferritin levels and a more sever clinical picture independently of age and gender became evident. Hyperferritinemic syndromes share clinical and serological features such as fever, cytopenias, multiorgan involvement and coagulopathy 53 , most of which can also be observed in COVID-19. In fact, despite a lung-centric immunopathology, currently available data suggest that the clinical spectrum of COVID-19 is not limited to lung involvement, but rather represents a multisystem illness 4 .…”

Section: Discussionmentioning

confidence: 99%

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

Carubbi

Salvati²,

Alunno

et al. 2021

Sci Rep

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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.

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Section: Discussionmentioning

confidence: 99%

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

Carubbi

Salvati²,

Alunno

et al. 2021

Sci Rep

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“…A positive correlation is observed between ferritin and the SOFA score [ 7 ]. For the elderly cohort with hyperferritinemia, patients with sepsis or solid malignancy have a worse prognosis than those with other diagnoses [ 19 ]. Consistently, we found that there was an obvious iron metabolism imbalance in the present sepsis cohort.…”

Section: Discussionmentioning

confidence: 99%

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

Fang

Zhang

Guo

et al. 2022

Emergency Medicine International

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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.

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“…(3) the severity of the initial COVID-19 infection was not evaluated for the SARS-CoV-2 IgG positive patients and (4) patients with prolonged course and more severe symptoms might present with more significant anemia and lower ferritin levels. (5) The current study focuses on an early period following the initial outbreak of COVID-19 in New York, suggesting a less than 6 months interval between COVID-19 infection and TJA surgery. However, data on the time interval between surgery and COVID-19 infection were not available and its impact on ferritin or hemoglobin levels remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Low blood levels of ferritin may be present in cases of iron deficiency anemia [ 10 ]. However, ferritin is also an acute-phase reactant that becomes elevated in response to acute inflammation [ 5 ], as proinflammatory cytokines trigger an increase in hepcidin, which in turn restricts uptake of dietary iron and promotes sequestration of iron by ferritin within storage sites [ 12 ]. Patients with inflammatory conditions may thus have restricted availability of iron for erythropoiesis and other cell functions due to increased hepcidin expression, despite normal or high levels of serum ferritin [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative ferritin and hemoglobin levels are lower in patients with a history of COVID-19 but blood loss and transfusion requirements are not increased

Jungwirth-Weinberger

Bendich

Westrich

et al. 2021

Arch Orthop Trauma Surg

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Introduction A history of COVID-19 (Coronavirus Disease 2019), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have an impact on hemoglobin and ferritin levels predisposing patients to increased blood transfusion requirements following total joint arthroplasty (TJA). The current study compares ferritin levels, hemoglobin levels, and transfusion rates between SARS-CoV-2 IgG positive and SARS-CoV-2 IgG negative TJA patients. Materials and methods Preoperative ferritin levels, pre- and postoperative hemoglobin levels, postoperative change in hemoglobin, and transfusion rates of 385 consecutive SARS-CoV-2 IgG positive patients undergoing TJA were compared to those of 5156 consecutive SARS-CoV-2 IgG negative patients undergoing TJA. Results Preoperative hemoglobin levels were significantly lower in SARS-CoV-2 IgG positive patients [13.3 g/dL (range 8.9–17.7 g/dL)] compared to 13.5 g/dl (7.3–18.3 g/dL; p value 0.03). Ferritin levels were significantly lower in SARS-CoV-2 IgG positive patients (mean of 106.1 ng/ml (2.1–871.3.3 ng/ml) vs. 123.7 ng/ml (1.4–1985 ng/ml) ( p value 0.02)). Hemoglobin on postoperative day (POD) one, after four–six weeks, and transfusion rates did not differ between the two groups. Conclusion Although preoperative hemoglobin and ferritin levels are lower in SARS-CoV2 IgG positive patients, there was no difference in hemoglobin on POD one, recovery of hemoglobin levels at four—six weeks postoperatively, and transfusion rates after surgery. Routine ferritin testing prior to TJA is not recommended in SARS-CoV-2 IgG positive patients.

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Hyperferritinemia in the elderly can differentiate the bad from the worst

Cited by 11 publications

References 22 publications

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

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

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

Preoperative ferritin and hemoglobin levels are lower in patients with a history of COVID-19 but blood loss and transfusion requirements are not increased

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