Predictive value of iron parameters in neurocritically ill patients

Abstract

BackgroundIron, an essential mineral for human body, has the potential to cause toxicity at high levels. Previous studies have shown inconsistent predictive value of iron parameters in critically ill patients. Thus, we aimed to evaluate the performance of iron parameters in outcome prediction of neurocritically ill patients.MethodsRetrospective data were collected from patients admitted to the neurocritical care unit (NCU) of a tertiary teaching hospital between August 2016 and January 2017. The iron parameters were obtained at NCU admission. Primary endpoints were short‐term (30‐day) mortality and long‐term (6‐month) poor outcome, with the latter defined as modified Rankin Scale of 4–6. The predictive value of variables was determined with univariate and multivariate logistic analysis. A further subanalysis was conducted in patients stratified by the level of estimated glomerular filtration rate (eGFR).ResultsOf 103 eligible patients, the etiology included stroke (58.2%, N = 60), central nervous system infection (13.6%, N = 14), and other neurologic disorders (28.2%, N = 29). The correlation analysis showed that the increase in ferritin, as well as the reduction in transferrin and total iron‐binding capacity, had strong correlation with C‐reactive protein, procalcitonin, duration of NCU stay, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score. In a further subanalysis of 75 patients with eGFR ≥ 60 ml/min/1.73 m2, twelve (16.0%) patients died within 30 days and 39 (52.0%) patients achieved good follow‐up outcome data. In the multivariate logistic regression analysis, we identified baseline ferritin level as an independent predictor of short‐term mortality (OR: 1.002; 95% CI: 1.000–1.003; p = 0.008) and long‐term functional outcome (OR: 1.002; 95% CI: 1.000–1.004; p = 0.031).ConclusionsSerum ferritin level at admission could be used as an independent predictor of short‐term mortality and long‐term functional outcome in neurocritically ill patients with eGFR ≥ 60 ml/min/1.73 m2.

Serum ferritin as a prognostic marker in acute stroke; a cross-sectional observational study

“…1 The molecular basis for the brain damage secondary to iron overload is due to the generation of radical hydroxyl from oxygen during reperfusion, increased excitotoxicity, and blood-brain barrier disruption. 16 Ferritin, being an acute-phase protein, should be estimated within 72 hours of symptom onset to eliminate any possible elevations in an acute phase reaction. We have analyzed the serum ferritin levels within 48 hours of admission and found a positive correlation between serum ferritin and the worse prognosis.…”

Evaluation of Serum Ferritin as a Prognostic Marker in Acute Hemorrhagic Stroke

“…25 Xie et al established serum ferritin to be an independent predictor of long-term functional outcome in neurocritically ill patients amidst all other iron indices. 26 There are also evidences validating that decreasing body iron by injecting iron chelators such as deferoxamine could alleviate the neuropathological changes of ICH in experimental animal models. 27,28 As elevated admission serum ferritin is associated with adverse ICH outcomes in the present study, the advantages of hypoferremia and iron lowering therapeutic targets in ICH patients could be the domains of future research.…”

Serum Level of Transferrin Unique Peptide Is Decreased in Patients With Acute Ischemic Stroke

“…Oxidative stress plays an important role in neuronal injuries and free iron is responsible for oxidative damage in the infarcted brain tissues ( 1 – 4 ). Serum ferritin level at admission could be used as an independent predictor of short-term mortality and long-term functional outcome in neurological critically ill patients ( 5 ). Increased serum ferritin levels at admission have been also associated with poor outcome in ischemic stroke ( 6 ).…”