Abnormal ferritin levels predict development of poor outcomes in cirrhotic outpatients: a cohort study

Abstract

Background Both iron overload and iron deficient anemia can associate with cirrhosis. At the same time, inflammation might be continuously present in cirrhotic patients due to bacterial translocation and patients’ susceptibility to infections. Ferritin is a sensitive and widely available marker of iron homeostasis, in addition it acts as an acute phase protein. Therefore, we evaluated the prognostic potential of serum ferritin in the long-term follow-up of cirrhotic outpatients. Methods A cohort of 244 cirrhotic outpatients was recruited and followed for 2 years. We measured their serum ferritin levels in our routine laboratory unit at enrolment and investigated its association with clinical outcomes. Results Ferritin serum level was higher in males and older patients than in females (median: 152.6 vs. 75 μg/L, p < 0.001) or younger individuals (median: 142.9 vs. 67.9 μg/L, p = 0.002). Patients who previously survived variceal bleeding had lower ferritin levels (median: 43.1 vs. 146.6 μg/L, p < 0.001). In multivariate regression models, including laboratory and clinical factors, lower (< 40 μg/L) ferritin concentration was associated with the development of decompensated clinical stage in patients with previously compensated cirrhosis (sHR: 3.762, CI 1.616–8.760, p = 0.002), while higher (> 310 μg/L) circulating ferritin levels were associated with increased risks of bacterial infections in decompensated patients (sHR: 2.335, CI 1.193–4.568, p = 0.013) and mortality in the whole population (HR: 2.143, CI 1.174–3.910, p = 0.013). Conclusion We demonstrated usefulness of serum ferritin as a prognostic biomarker in cirrhosis, pointing out that both low and high concentrations need attention in these patients.

Serum Ferritin as a Predictor of Outcomes in Hospitalized Patients with Covid-19 Pneumonia

“…Ferritin has previously been shown to be a predictor of poor outcomes 11,12 in patients with COVID-19. One meta-analysis of 25 studies and 5350 patients found that a higher serum ferritin level was independently associated with ARDS, mortality, and severe COVID-19.…”

Effect of elevated serum ferritin on the risk of death in patients with decompensated cirrhosis: a meta-analysis

“…The findings of Oikonomou were like those mentioned above -high serum ferritin levels are associated with poorer outcomes in patients with established decompensated cirrhosis [17]. Tornai et al found an association between high ferritin levels and mortality in Kaplan-Meier and univariate Cox regression analyses; however, they did not find high ferritin levels to be an independent predictor of mortality in the multivariate regression [18]. Most importantly, until now, no researcher has conducted a relevant meta-analysis.…”

“…It demonstrated, to some extent, that the serum ferritin cut-off values influence the study results and heterogeneity. Unfortunately, except for the study by Tornai 2021 [18] which described that high ferritin levels(>310 μg/l) were determined based on the 75th percentile of patients’ serum levels, the remaining studies, particularly those with the serum ferritin cut-off value of 200 ng/ml, did not provide a basis for indicating the source of the serum ferritin cut-off value. This makes it difficult to interpret the study results and heterogeneity according to the serum ferritin cut-off value.…”

“…The sensitivity analysis was carried out by omitting a single study per step, and the results showed that the pooled unadjusted HR in each step did not change substantially, indicating that our pooled result was robust to some extent (Supplementary Figure S7, Supplemental digital content 1, http://links.lww.com/ EJGH/A869). A total of five studies reported data on multivariate analysis [16][17][18]23,24], with elevated serum ferritin associated with increased mortality having a pooled adjusted HR of 1.44 (95% CI, 0.99-2.10). The result was not statistically significant, and the heterogeneity among the included studies was high (I 2 = 88.8%, P = 0.000) (Supplementary Figure S8, Supplemental digital content 1, http://links.lww.com/EJGH/A869); however, subgroup analysis by the cut-off value of serum ferritin demonstrated that intra-group heterogeneity was low in both the serum ferritin = 200 ng/ml group (I 2 = 0.0%, P = 0.355) and the serum ferritin > 200 ng/ml group (I 2 = 0.0%, P = 0.973), and a pooled adjusted HR in patients with serum ferritin = 200 ng/ml group was 1.545 (95% CI, 1.295-1.844) (Fig.…”

Cutoff Values for Serum Ferritin in"&#".ord($0).";""&#".ord($0).";"Predicting Cirrhosis Severity due to Cholestatic Jaundice in Vietnamese Children

“…Another study followed 244 cirrhotic patients for 2 years, reported by Tornai et al , which found that high ferritin levels were associated with an increased risk of infection in patients with acquired decompensated cirrhosis (hazard ratio 2.335, 95%, CI 1.193–4.568, p = 0.013) [ 16 ].…”