The relationship between serum ferritin level and clinical outcomes in sepsis based on a large public database

Abstract

This study aimed to investigate the relationship between serum ferritin level and prognosis in sepsis. It also explored the potential prognostic value of serum ferritin for predicting outcomes in sepsis based on a large public database. Sepsis patients in MIMIC-IV database were included. Different models including crude model (adjusted for none), model I (adjusted for age and gender) and model II (adjusted for all potential confounders) were performed. Smooth fitting curves were constructed for exploring the relationships between serum ferritin and mortalities of 28-day, 90-day, 180-day and 1-year. Receiver operator characteristic (ROC) curve analysis was utilized for assessing the predictive value of serum ferritin. 1947 sepsis patients were included. The mortalities of 28-day, 90-day, 180-day and 1-year were 20.18% (n = 393), 28.35% (n = 552), 30.30% (n = 590) and 31.54% (n = 614), respectively. In Model II (adjusted for all potential confounders), for every 1000 ng/ml increment in serum ferritin, the values of OR in mortalities of in 28-day, 90-day, 180-day and 1-year were 1.13 (95% CI 1.07–1.19, P < 0.0001), 1.15 (95% CI 1.09–1.21, P < 0.0001), 1.16 (95% CI 1.10–1.22, P < 0.0001) and 1.17 (95% CI 1.10–1.23, P < 0.0001), respectively. The relationships between serum ferritin level and outcomes were non-linear. The areas under the ROC curve (AUC) of ferritin for predicting mortalities of 28-day, 90-day, 180-day and 1-year were 0.597 (95% CI 0.563–0.629), 0.593 (95% CI 0.564–0.621), 0.595 (95% CI 0.567–0.623) and 0.592 (95% CI 0.564–0.620), respectively. The non-linear relationships between serum ferritin and clinical outcomes in sepsis were found. Serum ferritin had a predictive value for short-term and long-term outcomes in sepsis.

A Comprehensive Review on Serum Ferritin as a Prognostic Marker in Intensive Care Units: Insights Into Ischemic Heart Disease

“…Patients exhibiting elevated serum ferritin levels tend to experience a heightened incidence of severe illness and liver injury when compared to those with lower levels, as supported by research [ 25 ]. Within hospitalized populations, ferritin levels surpassing 2000 ng/ml have demonstrated a significant association with severe diseases, indicating a robust correlation between elevated ferritin levels and disease severity [ 26 ]. Serum ferritin has proven effective in discerning the severity of illness, evidenced by a high area under the receiver operating characteristic (ROC) curve, suggesting its potential as a prognostic marker for disease severity [ 25 ].…”

“…Assessments of serum ferritin's predictive capability for severity and mortality have yielded promising outcomes, with ferritin displaying slightly superior predictive value for mortality compared to severity [ 27 ]. Studies have unveiled nonlinear relationships between serum ferritin levels and clinical outcomes in conditions like sepsis, where incremental increases in ferritin levels correspond to elevated mortality risks at varying time points [ 26 ]. Across a spectrum of disorders, serum ferritin's potential prognostic and diagnostic values have been elucidated, underscoring its significance as a biomarker for evaluating disease severity and forecasting outcomes [ 26 ].…”

“…Regular monitoring of serum ferritin levels in critically ill patients, especially those afflicted with sepsis or multiple organ dysfunction syndrome (MODS), offers valuable insights into disease severity and prognosis [ 24 , 38 ]. Utilizing ferritin as a prognostic biomarker necessitates the establishment of optimal cut-off values to predict outcomes such as mortality, organ failure, and the necessity for mechanical ventilation, thereby facilitating risk assessment and informing clinical decision-making processes [ 26 , 38 ]. Moreover, the association between elevated serum ferritin levels and adverse outcomes in sepsis and critical illness underscores the imperative for targeted interventions to modulate iron metabolism and mitigate inflammatory responses [ 26 , 39 ].…”

“…Utilizing ferritin as a prognostic biomarker necessitates the establishment of optimal cut-off values to predict outcomes such as mortality, organ failure, and the necessity for mechanical ventilation, thereby facilitating risk assessment and informing clinical decision-making processes [ 26 , 38 ]. Moreover, the association between elevated serum ferritin levels and adverse outcomes in sepsis and critical illness underscores the imperative for targeted interventions to modulate iron metabolism and mitigate inflammatory responses [ 26 , 39 ]. Therapeutic strategies may encompass iron supplementation approaches for addressing iron deficiency or tailored treatments targeting hyperferritinemia syndromes linked with macrophage activation and systemic inflammation [ 39 ].…”

“…Furthermore, serum ferritin levels serve as a valuable tool for risk stratification in ICU patients, aiding clinicians in identifying high-risk individuals who may benefit from intensified monitoring, aggressive interventions, or specialized care pathways [ 24 , 26 ]. A comprehensive understanding of the relationship between serum ferritin dynamics and clinical outcomes, including mortality rates, organ failure occurrences, and duration of ICU stays, is pivotal in predicting patient trajectories and optimizing treatment plans [ 23 , 24 ].…”