Low serum transferrin correlates with acute‐on‐chronic organ failure and indicates short‐term mortality in decompensated cirrhosis

Bruns, Tony; Nuraldeen, Renwar; Mai, Martina; Stengel, Sven; Zimmermann, Henning W.; Yagmur, Eray; Trautwein, Christian; Stallmach, Andreas; Strnad, Pavel

doi:10.1111/liv.13211

Cited by 40 publications

(51 citation statements)

References 33 publications

(93 reference statements)

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“…This is in accordance with studies evaluating ferritin and transferrin as prognostic parameters in various liver diseases. A study including patients with decompensated cirrhosis and acute‐on‐chronic liver failure demonstrated a predictive value of transferrin for short‐term overall and transplant‐free survival, setting the optimal cut‐off point at 87 mg/dL . In our study, levels of transferrin greater than 155 mg/dL were associated with increased survival and better prognosis.…”

Section: Discussionsupporting

confidence: 48%

“…[2][3][4] Serum ferritin has been evaluated as a prognostic outcome marker in many clinical settings including alcoholic, non-alcoholic and viral hepatitis, cirrhosis and acute-on-chronic liver failure. [5][6][7][8][9][10][11] High ferritin and low transferrin saturation before liver transplantation were independent risk factors for long-term mortality following liver transplantation for chronic end-stage liver disease. 12 Transferrin concentration was decreased in alcohol induced cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

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Low transferrin and high ferritin concentrations are associated with worse outcome in acute liver failure

Anastasiou

Kälsch

Hakmouni

et al. 2017

Liver International

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Section: Discussionsupporting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Low transferrin and high ferritin concentrations are associated with worse outcome in acute liver failure

Anastasiou

Kälsch

Hakmouni

et al. 2017

Liver International

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“…Beyond the immediate implications for predicting outcomes, studying prognostic factors in patients with cirrhosis helps improve our understanding of disease pathogenesis and could ultimately lead to the identification of new therapeutic targets. Recent studies have shown that serum iron parameters are independent predictors of survival in patients awaiting liver transplantation, ACLF, and critically ill patients . A main finding of this study is that of all serum iron parameters, transferrin is the best prognostic parameter and it is independent of MELD‐Na.…”

Section: Discussionmentioning

confidence: 61%

“…Iron overload was therefore proposed as a risk factor for mortality in patients with liver disease. Accordingly, transferrin and transferrin saturation have also been identified as predictors of survival in patients with decompensated cirrhosis and acute‐on‐chronic liver failure (ACLF) . Transferrin is lower in patients with cirrhosis and impaired synthetic function .…”

mentioning

confidence: 99%

Transferrin as a predictor of survival in cirrhosis

Viveiros¹,

Finkenstedt²,

Schaefer³

et al. 2018

Liver Transpl

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Patients with cirrhosis frequently present with high serum ferritin and low transferrin concentrations, reflecting impaired liver function and inflammation. Recent studies have shown that transferrin and its saturation with iron are Model for End‐Stage Liver Disease–independent predictors of mortality in patients with acute‐on‐chronic liver failure or decompensated cirrhosis. The aim of this study was to evaluate the prognostic utility of serum iron parameters in relation to markers of liver function and immune activation. Clinical, demographic, and biochemical data were retrospectively analyzed from a cohort of 1255 consecutive patients with cirrhosis (age ≥ 18 years) who presented from August 1, 2004 until December 31, 2014 at the University Hospital of Innsbruck. Patients with malignancies at diagnosis including hepatocellular carcinoma were excluded. Survival analysis was carried out by Cox regression by using baseline laboratory parameters, and findings were validated in an independent patient cohort. During a median follow‐up of 2.4 years, 193 deaths occurred and 254 patients underwent liver transplantation. In patients with transferrin < 180 mg/dL, 3‐month, 1‐year, and 5‐year transplant‐free survival estimates were significantly lower (91.7%, 79.0%, and 30.5%) when compared with the group of patients with transferrin ≥ 180 mg/dL (98.9%, 95.5%, and 68.0%, P < 0.001). Transferrin predicted transplant‐free survival independently of Model for End‐Stage Liver Disease–sodium (MELD‐Na) and C‐reactive protein (CRP) in multivariate regression analysis including all patients. When patients with alcoholic or nonalcoholic fatty liver disease were excluded, transferrin was in addition an albumin‐independent predictor of transplant‐free survival. In conclusion, the association of transferrin with transplant‐free survival is independent of MELD‐Na score and CRP. In patients without fatty liver disease, transferrin also predicts survival independently of albumin. Liver Transplantation 24 343–351 2018 AASLD.

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“…In contrast, low serum transferrin and high Tsat were correlated significantly with poor short-term mortality (at 30 days). These results indicate the failure of iron homeostasis in patients with advanced liver disease and suggest possible therapeutic approaches in patients with ACLF [25]. …”

Section: Methodsmentioning

confidence: 99%

Iron deficiency anemia in chronic liver disease: etiopathogenesis, diagnosis and treatment

Gkamprela

Deutsch

Pectasides

2017

aog

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Chronic liver disease is accompanied by multiple hematological abnormalities. Iron deficiency anemia is a frequent complication of advanced liver disease. The etiology is multifactorial, mostly due to chronic hemorrhage into the gastrointestinal tract. The diagnosis of iron deficiency anemia is very challenging, as simple laboratory methods, including serum iron, ferritin, transferrin saturation (Tsat), and mean corpuscular volume are affected by the liver disease itself or the cause of the disease, resulting in difficulty in the interpretation of the results. Several new parameters, such as red blood cell ferritin, serum transferrin receptor test and index, and hepcidin, have been studied for their utility in indicating true iron deficiency in combination with chronic liver disease. Once iron deficiency anemia is diagnosed, it should be treated with oral or parenteral iron as well as portal pressure reducing drugs. Blood transfusion is reserved for symptomatic anemia despite iron supplementation.

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Low serum transferrin correlates with acute‐on‐chronic organ failure and indicates short‐term mortality in decompensated cirrhosis

Abstract: Among the investigated indicators of iron metabolism, serum transferrin concentration was the best indicator of organ failure and an independent predictor of short-term mortality at 30 days.

Cited by 40 publications

References 33 publications

Low transferrin and high ferritin concentrations are associated with worse outcome in acute liver failure

Low transferrin and high ferritin concentrations are associated with worse outcome in acute liver failure

Transferrin as a predictor of survival in cirrhosis

Iron deficiency anemia in chronic liver disease: etiopathogenesis, diagnosis and treatment

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