The detrimental impact of elevated Ferritin to Iron ratio on in-hospital prognosis of patients with COVID-19

Abstract

Background Acute viral infections, including coronavirus disease 2019 (COVID-19), are characterized by the dysregulation of iron metabolism, resulting in high serum ferritin and low iron levels. Research design and methods This study aimed to evaluate the prospective impact of iron metabolism dysregulation, as expressed by serum Ferritin-to-Iron Ratio (FIR), on the in-hospital prognosis of patients with COVID-19. Serum levels of ferritin and iron, as well as other iron metabolism markers and recognized prognostic indicators of COVID-19 severity, were measured in 362 patients consecutively hospitalized for COVID-19. The prospective relationship between FIR and the risk of the composite outcome of intensive care unit (ICU) admission/in-hospital death was analyzed. Results In the population examined (mean age 74 ± 15 years, males 55%), the rates of radiographic signs of pneumonia, respiratory distress, and the need for noninvasive ventilation were higher in patients with high FIR (≥29.2, the 75 th percentile) than in those with low FIR (<29.2, the 75 th percentile) (p < 0.05 for all comparisons). High FIR was associated with a 1.7-fold (HR 1.709, 95% CI 1.017–2.871, p = 0.043) higher risk of ICU admission/in-hospital death. Conclusions Increasing FIR values significantly and independently predicts worse in-hospital prognosis in hospitalized patients with COVID-19.

The Associations of Iron Related Biomarkers with Risk, Clinical Severity and Mortality in SARS-CoV-2 Patients: A Meta-Analysis

“…In addition, no significant differences were found in all analyses of TSAT (SMD (95%CI): −0.112 (−0.455, 0.231), Z = 0.64, p for Z = 0.521; I 2 = 59.6%, p for I 2 = 0.084; Table 2, Figure 11). [8,10,12,13] on TIBC levels in non-survivors and survivors. The solid diamond Figure 9.…”

“…Previous studies have investigated the relationships among iron, ferritin, hemoglobin, hepcidin, TIBC, TSAT and COVID-19, but their results are conflicting and inconsistent. Most studies about serum iron have shown that lower iron levels are found in more at-risk groups, such as non-survivors compared to survivors [8][9][10][11][12][13], severe disease groups compared to non-severe disease groups [10,[13][14][15][16] and cases to controls [10,[16][17][18][19][20][21], whereas others expressed the opposite results [7,22,23]. In all relevant studies, the hemoglobin levels were found to be lower in severe groups than those in controls [7,10,24] or non-severe groups [22,[25][26][27][28][29].…”

“…However, in the comparisons between severity [7,10,15,[17][18][19]23,24,[30][31][32][33][34][35][36][37] and mortality [10,30,[38][39][40][41], there was not a consistent numerical magnitude relationship between them. In addition, studies on TIBC [8,10,12,13] and TSAT [8,13] only refer to mortality. Most of those studies found lower levels in nonsurvivor groups, except for one about TSAT [10].…”

“…Lower levels of hepcidin in cases than controls was documented in a study [10], whereas the other studies reported an inverse result [18,20,24]. Unusually, more dangerous groups had higher ferritin levels in almost all relevant comparisons [4,6,[10][11][12][13][14][15][17][18][19][20][21][22][24][25][26][27][28][29][30]32,[34][35][36][37][38][39][40].…”

Thyroid-Stimulating Hormone Predicts Total Cholesterol and Low-Density Lipoprotein Cholesterol Reduction during the Acute Phase of COVID-19

“…The onset of coronavirus disease 2019 (COVID-19) is linked to a complex metabolic perturbation, which has a possible pathogenic role in the development of a systemic clinical syndrome leading to multiorgan dysfunction and life-threatening complications [ 1 , 2 , 3 ]. Thus, different biochemical abnormalities reflecting metabolism derangement have been associated with poor clinical outcomes of COVID-19 and have risen interest as possible therapeutic targets against COVID-19 [ 4 , 5 , 6 ].…”