Time Course of Iron Metabolism in Critically Ill Patients

Piagnerelli, Michaël; Cotton, Frédéric; Herpain, Antoine; Rapotec, Alessandro; Chatti, R.; Gulbis, Béatrice; Vincent, Jean‐Louis

doi:10.2143/acb.68.1.2062715

Cited by 22 publications

(14 citation statements)

References 40 publications

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“…Alternatively, low circulating concentrations of transferrin could represent an important source of catalytic iron. Transferrin is a negative acute-phase reactant that declines rapidly in critical illness, 32 and we observed transferrin concentrations on day 1 that were well below reference ranges in healthy adults. Lower transferrin concentrations in critically ill patients with AKI could increase the amount of nontransferrin-bound iron and, thus, the amount of catalytic iron in the circulation as a consequence of reduced iron-carrying capacity.…”

Section: Discussionmentioning

confidence: 54%

Iron, Hepcidin, and Death in Human AKI

Leaf

Rajapurkar²,

Lele³

et al. 2019

JASN

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Background Iron is a key mediator of AKI in animal models, but data on circulating iron parameters in human AKI are limited.Methods We examined results from the ARF Trial Network study to assess the association of plasma catalytic iron, total iron, transferrin, ferritin, free hemoglobin, and hepcidin with 60-day mortality. Participants included critically ill patients with AKI requiring RRT who were enrolled in the study. ResultsOf the 807 study participants, 409 (51%) died by day 60. In both unadjusted and multivariable adjusted models, higher plasma concentrations of catalytic iron were associated with a significantly greater risk of death, as were lower concentrations of hepcidin. After adjusting for other factors, patients with catalytic iron levels in the highest quintile versus the lowest quintile had a 4.06-fold increased risk of death, and patients with hepcidin levels in the lowest quintile versus the highest quintile of hepcidin had a 3.87-fold increased risk of death. These findings were consistent across multiple subgroups. Other iron markers were also associated with death, but the magnitude of the association was greatest for catalytic iron and hepcidin. Higher plasma concentrations of catalytic iron and lower concentrations of hepcidin are each independently associated with mortality in critically ill patients with AKI requiring RRT.Conclusions These findings suggest that plasma concentrations of catalytic iron and hepcidin may be useful prognostic markers in patients with AKI. Studies are needed to determine whether strategies to reduce catalytic iron or increase hepcidin might be beneficial in this patient population.

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Section: Discussionmentioning

confidence: 54%

Iron, Hepcidin, and Death in Human AKI

Leaf

Rajapurkar²,

Lele³

et al. 2019

JASN

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“…Critically ill patients, including those with sepsis, develop anaemia in up to 70% of cases, of which 44-50% will require a blood transfusion [16,17,18]. In septic patients, blood transfusion are required in up to 50% of cases due to a normocytic, normochromic anaemia with low iron, low transferrin but high ferritin, which usually develops through altered iron metabolism and erythropoiesis [17][18][19][20][21][22]. This is due to the inflammatory response stimulated by surgical sepsis and stress leading to elevated inflammatory markers, which inversely correlates with Hb levels [21,23,24].…”

Section: Pathophysiology Of Anaemia In Surgical Stress and Sepsismentioning

confidence: 99%

Anaemia in Surgical Sepsis and Stress: The Roles of Erythropoietin, Iron and Steroids

Smits¹,

Hart²,

Sivarajah³

et al. 2019

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Background: Inflammation in surgical sepsis and stress frequently causes anaemia, leading to increased rates of blood transfusions. Recent evidence shows that blood transfusions carry a greater risk for short-and longterm complications than previously thought. Objective: To review the role of erythropoietin (EPO), iron and/or steroids as an alternative treatment to blood transfusions in critically ill patients. Methodology: A systematic review was prepared from recent literature on inflammation-induced anaemia, anaemia in the critically ill and/or septic patient and the roles of EPO, iron and corticosteroids in these patients. A meta-analysis was completed for EPO. Results: Inflammatory cytokines alter haematopoietic and biochemical pathways, leading to anaemia. Inflammation decreases circulating EPO and upregulates hepcidin, resulting in decreased free iron. Twelve randomised-controlled trials demonstrate that EPO administration in critically ill patients reduces the need for blood transfusions by 31% (p=0.005) however does not significantly decrease mortality (p=0.15). Intravenous iron also reduces the need for blood transfusions but has not been utilised in sepsis-associated anaemia. No trials focusing on the effects of steroids on sepsis-associated anaemia were identified. Conclusion: Due to the lack of data specific to sepsis-associated anaemia in post-operative patients, the roles of EPO, iron and steroids remain under investigation. More research specific to surgical patients is needed.

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“…Обнаружено также, что при ВГФС частота спленомегалии, уровень триглицеридов, ферритина, аланин-(АлАТ) и аспартатаминотрансферазы (АсАТ) статистически значимо выше, чем при сепсисе, а уровень гликозилированного ферритина (%ГФ), фибриногена, лейкоцитов, нейтрофилов и тромбоцитов -ниже. Приведены медианы (1-3-й квартиль) значений в группах пациентов с ВГФС и сепсисом соответственно: триглицериды (ммоль/л) -3,1 (2,3-3,8) и 1,5 (0,8-2,7), общий ферритин (нг/мл) -7170 (3159,2-12551,0) и 1274 (559,0-3041,5), %ГФ -26,5 (16,3) и 54,5 (37,8), фибриноген (г/л) -2,8 (1,4-4,4) и 5,3 (2,8), АлАТ (МЕ/л) -50 (20-102) и 30 (15,5), АсАТ (МЕ/л) -66 (40,6) и 36 (24,0), лейкоциты (×10 9 /л) -3,7 (2,1-5,5) и 8,9 (6,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)5), тромбоциты (×10 9 /л) -56 (25,2-93,5) и 157 (97-308). По данным ROC-анализа, площадь под кривой для уровня нейтрофилов составила 0,88, общего ферритина, %ГФ, лейкоцитов и тромбоцитов -0,85, триглицеридов -0,74, фибриногена -0,71, натрия -0,65, АлАТ и АсАТ -0,61.…”

Section: клиническая онкогематологияunclassified

“…При этом концентрация ферритина может достигать десятков и даже сотен тысяч нг/мл [11][12][13]. При воспалении, в т. ч. и сепсисе, гиперферритинемия также может достигать значений в несколько тысяч нг/мл, приближаясь к уровню, отмечающемуся при ВГФС [14][15][16].…”

Section: Introductionunclassified

Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis

Потапенко¹,

Первакова²,

Титов³

et al. 2019

Клиническая онкогематология

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Актуальность. Вторичный гемофагоцитарный синдром (ВГФС) и сепсис при всей схожести клинических проявлений и лабораторных параметров принципиально различаются по применяемым при этих заболеваниях методам лечения. При ВГФС лечение направлено на достижение иммуносупрессии, а при сепсисе проводится противоинфекционная терапия. Для выбора правильной лечебной тактики необходима быстрая дифференциальная диагностика между заболеваниями. Цель. Поиск и анализ критериев дифференциальной диагностики ВГФС и сепсиса. Материалы и методы. Проанализированы данные 102 пациентов: 55-с ВГФС (медиана возраста 60 лет, диапазон 18-81 год) и 47-с сепсисом (медиана возраста 60 лет, диапазон 18-89 лет). Диагноз ВГФС установлен на основании критериев HLH-2004 и H-Score. Сепсис верифицирован при документированном очаге

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Time Course of Iron Metabolism in Critically Ill Patients

Abstract: Iron status is rapidly altered in critically ill patients, especially in septic patients. These alterations persist during the course of the disease and are associated with decreased erythropoiesis.

Cited by 22 publications

References 40 publications

Iron, Hepcidin, and Death in Human AKI

Iron, Hepcidin, and Death in Human AKI

Anaemia in Surgical Sepsis and Stress: The Roles of Erythropoietin, Iron and Steroids

Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis

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