Hyperferritinemia is a risk factor for steatosis in chronic liver disease

Abstract

AIM:To investigate the relationship between ferritin and steatosis in patients with chronically abnormal liver function tests (LFTs) and high ferritin level. METHODS:One hundred and twenty-four consecutive patients with hyperferritinemia (male > 300 ng/mL, female > 200 ng/mL) were evaluated; clinical, biochemical and serological data, iron status parameters, HFE gene mutations and homeostasis model assessment score were obtained. Steatosis was graded by ultrasound as absent or present. Histology was available in 53 patients only.RESULTS: Mean level of ferritin was 881 ± 77 ng/mL in men and 549 ± 82 ng/mL in women. The diagnosis was chronic hepatitis C in 53 (42.7%), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in 57 (45.9%), and cryptogenic liver damage in 14 (11.3%). None was diagnosed as hereditary hemochromatosis (HH). Hepatic siderosis on liver biopsy was present in 17 of 54 (32%) patients; grade 1 in eight and grade 2 in nine. Overall, 92 patients (74.2%) had steatosis. By logistic regression, ferritin and g-glutamyltransferase were independent predictors of steatosis. Ferritin levels were significantly related to low platelet count, steatosis and hepatitis C virus infection. CONCLUSION:In a non-obese cohort of non-alcoholic patients with chronically abnormal LFTs without HH, high serum ferritin level is a risk factor for steatosis.

Severe iron overload and hyporegenerative anemia in a case with rhesus hemolytic disease: therapeutic approach to rare complications

“…In the case of insulin resistance, increased insulin and proinflammatory cytokines and decreased hemojevulin and ferroportin-1 from hepatocytes are attributed to iron deposits due to decreased iron excretion from hepatocytes. Furthermore, in chronic hepatitis C infection, decreased hepcidin also leads to iron deposits as well as insulin resistance [18,19]. In our patient, overload iron deposits could have caused the liver damage, or on the other hand, liver damage could have led to iron deposits via its effect on hepcidin, hemojevulin and ferroportin-1 metabolism.…”

Hepato-cardiac disorders

“…Hemochromatosis: Hemochromatosis is an autosomal recessive disorder affecting the white population. In this disorder, the inappropriate absorption and deposi- tion of dietary iron may result in the development of hepatic and non-hepatic end-organ injury, leading to liver cirrhosis, hepatocellular carcinoma, diabetes, arthritis, skin pigmentation and cardiac diseases [131] . Cardiac involvement in hemochromatosis affects mainly the myocardium: iron overload of the myocytes reduces left ventricular distensibility.…”

Noninvasive predictors for liver fibrosis in patients with nonalcoholic steatohepatitis

“…Licata et al [63] pointed out that high serum ferritin level is a risk factor for steatosis. Fracanzani et al [38] said that fibrosis was independently associated with elevated serum ferritin and normal ALT level is not a reliable parameter to exclude patients from liver biopsy.…”