Intravenous iron supplementation after liver surgery: Impact on anemia, iron, and hepcidin levels—a randomized controlled trial

Abstract

Background: Anemia is a recognized risk factor for perioperative related morbidity and mortality and is frequently reported in liver surgeries with an estimated incidence of 32%. We aim to assess the impact of intravenous iron administration in the immediate postoperative period on anemia and iron status as well as to determine the kinetics of hepcidin after liver surgery. Methods: The HepciFer trial, a randomized controlled trial, included 50 patients undergoing liver surgery. In accordance with the randomization process, patients received either ferric carboxymaltose (15 mg/kg, maximum 1 g) or placebo 4 hours after surgery. Results: The mean hemoglobin level, 7 days after surgery, did not differ significantly between the intervention and control group (11.1 ± 1.8 g/dL and 10.4 ± 1.6 g/dL, respectively) with a mean difference of þ0.7 g/dL ([95% confidence interval, À0.3 to þ1.7], P ¼ .173). Within patients receiving intravenous iron supplementation, none presented biological signs of functional iron deficiency. Hepcidin levels remained significantly higher during the observation period in the intervention group. Inflammatory biomarkers, red blood cells transfusion rate and hospital duration of stay were similar between groups. Conclusion: Intravenous ferric carboxymaltose administration did not result in a significant increase of hemoglobin levels 7 days after surgery. However, this study suggests that intravenous iron supplementation in the immediate postoperative settings prevents functional iron deficiency. Intravenous iron supplementation overcame the hepcidin-mediated blockade of iron absorption and should be considered as the preferred route of administration in the postoperative period.

Iron Replacement and Redox Balance in Non-Anemic and Mildly Anemic Iron Deficiency COPD Patients: Insights from a Clinical Trial

“…Moreover, the delta change of the iron metabolism variables between the iron-treated and the placebo groups of patients also significantly improved in the former patients compared to the latter. These findings are consistent with previous investigations conducted in patients with liver surgery and anemic diseases [28,[51][52][53]. Collectively, these results suggest that iron replacement favored the optimization of iron metabolism even in non-anemic patients.…”

“…Collectively, these results suggest that iron replacement favored the optimization of iron metabolism even in non-anemic patients. Interestingly, no significant differences were seen in IL-6 levels after treatment with iron, findings that had also been previously reported [51].…”

Presurgical mild anemia is a risk factor for severe postoperative complications of rectal cancer surgery: A Japanese nationwide retrospective cohort study

“…19 The HepciFer trial, a randomized controlled trial, which included 50 patients undergoing liver surgery concluded that intravenous ferric carboxymaltose administration did not result in a significant increase of hemoglobin levels 7 days after surgery. 34 This study had additional limitations that should be considered when interpreting the results. The limited number of patients with severe anemia restricted evaluation of the risk of severe complications Fifteen risk adjustment factors (described in Section 2) were used to calculate riskadjusted odds ratios based upon anemia severity.…”

Intravenous iron for critically ill children. Comparison of three dose regimens

“…However, inflammatory status can inhibit erythropoiesis directly and indirectly, reducing sTfR levels, being less reliable with higher degrees or inflammation 19 . Besides, although some studies showed changes in sTfR after IV iron treatment, 28 sTfR is not widely used due to lack of standardization and variations in assay types.…”