Iron metabolism in critically ill patients developing anemia of inflammation: a case control study

Bos, Lieuwe D. J.; Binnekade, Jan M.; Nota, Benjamin; Groep, Kirsten van de; Cremer, Olaf L.; Tuinman, Pieter R.; Horn, Janneke; Schultz, Marcus J.; Bruggen, Robin van; Juffermans, Nicole P.

doi:10.1186/s13613-018-0407-5

Cited by 27 publications

(16 citation statements)

References 41 publications

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“…Moreover, iron has multiple regulatory effects on immune function, among others blocking anti-microbial immune pathways or stimulating the production of the anti-inflammatory cytokine IL-10 [ 10 ]. As a consequence, this functional iron deficiency leads to anemia of inflammation (AI) or anemia of chronic disease (ACD) which is also found in critically ill patients [ 11 , 12 ] (Additional file 1 ). ACD is diagnosed upon the presence of reduced hemoglobin levels, increased concentrations of inflammation markers, low circulating iron levels, a reduced saturation of transferrin, along with normal or increased concentrations of ferritin [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Linkage of alterations in systemic iron homeostasis to patients’ outcome in sepsis: a prospective study

et al. 2020

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Background Sepsis, a dysregulated host response following infection, is associated with massive immune activation and high mortality rates. There is still a need to define further risk factors and laboratory parameters predicting the clinical course. Iron metabolism is regulated by both, the body’s iron status and the immune response. Iron itself is required for erythropoiesis but also for many cellular and metabolic functions. Moreover, iron availability is a critical determinant in infections because it is an essential nutrient for most microbes but also impacts on immune function and intravascular oxidative stress. Herein, we used a prospective study design to investigate the putative impact of serum iron parameters on the outcome of sepsis. Methods Serum markers of iron metabolism were measured in a prospective cohort of 61 patients (37 males, 24 females) with sepsis defined by Sepsis-3 criteria in a medical intensive care unit (ICU) and compared between survivors and non-survivors. Regulation of iron parameters in patients stratified by focus of infection and co-medication as well as association of the markers with sepsis severity scores and survival were investigated with linear and logistic regression corrected for sex and age effects. Results Positive correlations of increased serum iron and ferritin concentrations upon ICU admission with the severity of organ failure (SOFA score) and with mortality were observed. Moreover, high TF-Sat, elevated ferritin and serum iron levels and low transferrin concentrations were associated with reduced survival. A logistic regression model consisting of SOFA and transferrin saturation (SOFA–TF-Sat) had the best predictive power for survival in septic ICU patients. Of note, administration of blood transfusions prior to ICU admission resulted in increased TF-Sat and reduced survival of septic patients. Conclusions Our study could show an important impact of serum iron parameters on the outcome of sepsis. Furthermore, we identified transferrin saturation as a stand-alone predictor of sepsis survival and as a parameter of iron metabolism which may in a combined model improve the prediction power of the SOFA score. Trial registration The study was carried out in accordance with the recommendations of the Declaration of Helsinki on biomedical research. The study was approved by the institutional ethics review board of the Medical University Innsbruck (study AN2013-0006).

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Section: Introductionmentioning

confidence: 99%

Linkage of alterations in systemic iron homeostasis to patients’ outcome in sepsis: a prospective study

et al. 2020

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“…Also, the interaction between inflammation and iron metabolism may interfere with other inflammatory anemia-associated parameters and complicate iron metabolism in patients with sepsis [7, 8, 12, 16–18]. Typically, plasma ferritin (which stores iron) is reduced in iron deficiency anemia but can increase in the acute phase of sepsis [16, 19].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory anemia-associated parameters are related to 28-day mortality in patients with sepsis admitted to the ICU: a preliminary observational study

Jiang

Kong

et al. 2019

Ann. Intensive Care

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Background Anemia is one of the most common complications of sepsis. Sepsis-related anemia is associated mainly with inflammation. We aimed to observe the changes in the inflammatory anemia-associated parameters of patients with sepsis in the early stage of intensive care unit (ICU) admission and to evaluate their association with 28-day mortality. Methods A total of 198 patients with sepsis were divided into survivor ( n = 110) and non-survivor ( n = 88) groups on the basis of 28-day survival. Healthy volunteers ( n = 20) were enrolled as a control group. Plasma levels of iron, ferritin, erythropoietin (EPO), soluble transferrin receptor (sTfR), hepcidin, interleukin-6 (IL-6), hemoglobin and the red blood cell distribution width (RDW) were measured on days 1, 3 and 7 of ICU admission. Clinical data and laboratory findings were collected, and the Sequential Organ Failure Assessment (SOFA) score was calculated. Results Patients with sepsis showed significant decreases in hemoglobin, plasma iron and sTfR/log ferritin and significant increases in plasma EPO, sTfR, hepcidin, ferritin and IL-6 on days 1, 3 and 7 of ICU admission compared with healthy volunteers. Hemoglobin was correlated negatively with plasma IL-6 and hepcidin. In patients with sepsis, non-survivors had significantly lower plasma iron, EPO and sTfR/log ferritin, but higher plasma hepcidin, ferritin and IL-6 than survivors on days 1, 3 and 7 of ICU admission. Plasma EPO, hepcidin, ferritin, IL-6, sTfR/log ferritin, the RDW and SOFA score were associated significantly with 28-day mortality but to a varying extent. In particular, in predicting 28-day mortality, plasma hepcidin had an area under the receiver operating curve of 0.808 and 87.3% specificity, which was the highest among the inflammatory anemia-associated parameters tested. Conclusions Inflammatory anemia-associated parameters changed significantly in patients with sepsis in the first week of ICU admission. Plasma EPO, hepcidin, ferritin, IL-6, sTfR/log ferritin, the RDW and SOFA score were associated significantly with 28-day mortality. Plasma hepcidin might have a superior predictive value, with high specificity, compared with other inflammatory anemia-associated parameters for 28-day mortality of sepsis patients in the ICU. Electronic supplementary material The online version of this article (10.1186/s13613-019-0542-7) contains supplementary material, which is available to authorized users.

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“…У пациентов с сепсисом, поступающих в ОРИТ, по мнению ряда аторов, быстро развивается анемия, что подтвердили другие исследования [37][38][39]. Анемия воспаления часто встречается у пациентов с сепсисом в условиях ОРИТ, что подтверждается снижением уровня гемоглобина вместе с изменениями параметров, связанных с анемией воспаления.…”

Section: железо и сепсисunclassified

Iron metabolismin conditions of infection. Review

Orlov

Govorova

Лукач

et al. 2021

Annals of Critical Care

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The purpose of writing the review. Analysis of publications on the role of iron metabolism in the manifestation of the septic process and the dependence of bacterial flora activity on the conditions of their access to iron. Methods. More than 200 publications in pubmed, Medline, EMBASE medical literature databases were analyzed between 2000 and 2018 using the search words: iron and infection, iron and sepsis, iron exchange, iron and bacteria - including and available works in domestic (e-library) literature. Results. The review uses materials from 61 publications that meet the challenges of the search and reflect both the relationship between iron exchange and the development of the septic process and the importance for the medical community of understanding the identified relationships in the search for future therapeutic approaches. Conclusion. The review provides evidence of direct iron involvement in the manifestation of the septic process caused by various bacterial (q/-) and fungal flora. Introduction of iron-hesing agents and ciderophon - conjugate drugs to infected patients today seems to be a biologically acceptable approach as an auxiliary therapy in the treatment of septic process caused by pathogens dependent on iron supply (many bacterial and fungal pathogens), but the problem that is being raised certainly requires further experimental and clinical research.

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Iron metabolism in critically ill patients developing anemia of inflammation: a case control study

Cited by 27 publications

References 41 publications

Linkage of alterations in systemic iron homeostasis to patients’ outcome in sepsis: a prospective study

Linkage of alterations in systemic iron homeostasis to patients’ outcome in sepsis: a prospective study

Inflammatory anemia-associated parameters are related to 28-day mortality in patients with sepsis admitted to the ICU: a preliminary observational study

Iron metabolismin conditions of infection. Review

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