High Serum Iron level is Associated with Increased Mortality in Patients with Sepsis

Abstract

Iron is an essential nutrient for bacterial survival and thus higher iron levels may precipitate bacterial infections. We investigated the association between the serum iron level and prognosis in patients with sepsis by using the single-centre Medical Information Mart for Intensive Care III (MIMIC-III) database. Sepsis patients with iron parameters measured on ICU admission were included and stratified according to quartiles of serum iron levels. A total of 1,891 patients diagnosed with sepsis according to the Sepsis-3 criteria were included in this study, 324 of whom were septic shock. After adjusting for confounding variables, higher iron quartile was associated with an increase in 90-day mortality in the Cox regression analysis. Moreover, a stepwise increase in the risk of 90-day mortality was observed as the quartiles of serum iron levels increased in the patients with sepsis. In conclusion, higher serum iron levels were independently associated with increased 90-day mortality in this large cohort of patients with sepsis.

Hepcidin-Mediated Hypoferremia Disrupts Immune Responses to Vaccination and Infection

“… 35 Low serum iron correlated with lymphopenia, and extremely low serum iron (~3 μmol/L) identified COVID-19 patients with severe respiratory hypoxemia, likely secondary to pulmonary damage. This hypoferremia is more profound than in previously reported cohorts of non-COVID-19 ICU patients, including those with sepsis, 36 , 37 indicating that extreme hypoferremia may be a particular feature of severe COVID-19 disease. IL-6 drives hepcidin expression, and an unbalanced inflammatory response of high IL-6 and relatively low type I and type III IFN associates with severe COVID-19 and poor outcomes.…”

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

“…Moreover, the functional associations of alterations in markers of iron metabolism and the prognosis of septic patients are still incompletely understood. Several reports have shown that parameters of iron metabolism are predictors for outcome in ICU patients [16][17][18][19]. Nonetheless, there is still the need for more reliable biomarkers to predict the survival in ICU patients and to combine these with established clinical scores.…”

Iron metabolismin conditions of infection. Review

“…Хелатирование железа было предложено в качестве потенциальной терапии полибактериального абдоминального сепсиса [56]. Известно, что лечение хелатированием железа способно ослаблять рост бактерий [57].…”

“…В противовес сказанному другие исследования показали, наоборот, рост заболеваемости и смертности у пациентов, получающих переливание крови [56]. В исследование Р. Lan (2018) был включен 1891 больной с диагнозом «сепсис» по критериям сепсис-3, из которых у 324 был септический шок.…”

“…Более того, при повышении уровня железа в сыворотке крови у больных с сепсисом наблюдалось поэтапное повышение риска 90-дневной смертности. Авторы сделали заключение, что более высокие уровни железа в сыворотке крови независимо связаны с увеличением 90-дневной смертности в этой большой когорте пациентов с сепсисом [56].…”