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. 2020 Jul 29;9(8):2429.
doi: 10.3390/jcm9082429.

Prevalence and Predictive Value of Anemia and Dysregulated Iron Homeostasis in Patients with COVID-19 Infection

Rosa Bellmann-Weiler  1 , Lukas Lanser  1 , Robert Barket  1 , Lukas Rangger  1 , Anna Schapfl  2 , Marc Schaber  2 , Gernot Fritsche  1 , Ewald Wöll  2 , Günter Weiss  1
Affiliations

Prevalence and Predictive Value of Anemia and Dysregulated Iron Homeostasis in Patients with COVID-19 Infection

Rosa Bellmann-Weiler et al. J Clin Med. .

Abstract

Infections with SARS-CoV-2 can result in severe clinical manifestations. As such patients present with systemic inflammation, we studied the prevalence and predictive value of anemia of inflammation (AI) or functional iron deficiency (FID), originating from immune-mediated alterations of iron homeostasis. Within this retrospective analysis of 259 hospitalized patients with COVID-19, we found that, upon admission, 24.7% were anemic, with the majority suffering from AI (68.8%). Anemia was associated with a significantly higher in-hospital mortality (OR 3.729 (95%CI 1.739-7.995), p = 0.001) but not an increased frequency of intensive care unit (ICU) admission or need for mechanical ventilation. FID was present in 80.0% of patients upon admission, linked to more advanced inflammation and associated with significantly longer hospital stay. Notably, a ferritin/transferrin ratio > 10 predicted a five-fold higher risk of ICU admission and an eight-fold higher risk of the need for mechanical ventilation. Anemia and alterations of iron homeostasis are highly prevalent in hospitalized COVID-19 patients. Iron metabolism biomarkers and hemoglobin can contribute to risk stratification of patients, as initial anemia is associated with increased mortality, whereas alterations of iron homeostasis with a higher ferritin/transferrin ratio reflect more advanced inflammation and predicts subsequent insufficient pulmonary oxygenation with the need for ICU admission and mechanical ventilation.

Keywords: COVID-19 outcome; SARS-CoV-2; anemia; iron metabolism.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) prevalence of multifactorial anemia, anemia of inflammation (AI) and/or iron deficiency anemia (IDA) in patients who died or survived; (b) Kaplan–Meier survival curve of anemic and non-anemic patients (HR 2.678 (95%CI 1.335 – 5.376), p = 0.006); (c) prevalence of ferritin/transferrin ratio > 10 vs. ≤ 10 in patients with or without intensive care unit (ICU) admission; (d) Prevalence of ferritin/transferrin ratio > 10 vs. ≤ 10 in patients with or without mechanic ventilation.
See this image and copyright information in PMC

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