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. 2021 Apr 9;156(7):324-331.
doi: 10.1016/j.medcli.2020.11.030. Epub 2020 Dec 25.

Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19

[Article in English, Spanish]
Fuxue Deng  1 , Lisha Zhang  1 , Lyu Lyu  1 , Ziwei Lu  1 , Dengfeng Gao  1 , Xiaorong Ma  2 , Yonghong Guo  3 , Rong Wang  1 , Shouping Gong  4 , Wei Jiang  5
Affiliations

Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19

[Article in English, Spanish]
Fuxue Deng et al. Med Clin (Barc). .

Abstract
in English, Spanish

Background: The aim of this study was to evaluate hyperferritinemia could be a predicting factor of mortality in hospitalized patients with coronavirus disease-2019 (COVID-19).

Methods: A total of 100 hospitalized patients with COVID-19 in intensive care unit (ICU) were enrolled and classified into moderate (n=17), severe (n=40) and critical groups (n=43). Clinical information and laboratory results were collected and the concentrations of ferritin were compared among different groups. The association between ferritin and mortality was evaluated by logistic regression analysis. Moreover, the efficiency of the predicting value was assessed using receiver operating characteristic (ROC) curve.

Results: The amount of ferritin was significantly higher in critical group compared with moderate and severe groups. The median of ferritin concentration was about three times higher in death group than survival group (1722.25μg/L vs. 501.90μg/L, p<0.01). The concentration of ferritin was positively correlated with other inflammatory cytokines, such as interleukin (IL)-8, IL-10, C-reactive protein (CRP) and tumor necrosis factor (TNF)-α. Logistic regression analysis demonstrated that ferritin was an independent predictor of in-hospital mortality. Especially, high-ferritin group was associated with higher incidence of mortality, with adjusted odds ratio of 104.97 [95% confidence interval (CI) 2.63-4185.89; p=0.013]. Moreover, ferritin had an advantage of discriminative capacity with the area under ROC (AUC) of 0.822 (95% CI 0.737-0.907) higher than procalcitonin and CRP.

Conclusion: The ferritin measured at admission may serve as an independent factor for predicting in-hospital mortality in patients with COVID-19 in ICU.

Antecedentes: El objetivo de este estudio fue evaluar si la hiperferritinemia podría ser un factor predictivo de la mortalidad en pacientes hospitalizados con enfermedad por coronavirus de 2019 (COVID-19).

Métodos: Se incluyó un total de 100 pacientes hospitalizados con COVID-19 en la unidad de cuidados intensivos (UCI), clasificándose como grupos moderado (n = 17), grave (n = 40) y crítico (n = 43). Se recopiló la información clínica y de laboratorio, comparándose los niveles de ferritina entre los diferentes grupos. Se evaluó la asociación entre ferritina y mortalidad mediante un análisis de regresión logística. Además, se evaluó la eficacia del valor predictivo utilizando la curva ROC (receiver operating characteristic).

Resultados: La cantidad de ferritina fue significativamente superior en el grupo de pacientes críticos en comparación con el grupo de pacientes graves. La media de concentración de ferritina fue cerca de 3 veces superior en el grupo de muerte que en el grupo de supervivientes (1.722,25 μg/L vs. 501,90 μg/L, p < 0,01). La concentración de ferritina guardó una correlación positiva con otras citoquinas inflamatorias tales como interleucina (IL)-8, IL-10, proteína C reactiva (PRC) y factor de necrosis tumoral (TNF)-α. El análisis de regresión logística demostró que la ferritina era un factor predictivo independiente de la mortalidad intrahospitalaria. En especial, el grupo de ferritina alta estuvo asociado a una mayor incidencia de la mortalidad, con un valor de odds ratio ajustado de 104,97 [intervalo de confianza (IC) del 95% 2,63-4.185,89; p = 0,013]. Además, el valor de ferritina tuvo una ventaja de capacidad discriminativa en el área bajo la curva ROC (AUC) de 0,822 (IC 95% 0,737-0,907] superior al de procalcitonina y PRC.

Conclusión: El valor de ferritina medido durante el ingreso puede servir de factor independiente para prevenir la mortalidad intrahospitalaria en los pacientes de COVID-19 en la UCI.

Keywords: COVID-19; Ferritin; Ferritina; Inflammation markers; Marcadores inflamatorios; Mortalidad; Mortality; SARS-CoV-2.

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Figures

Fig. 1
Fig. 1
Correlation analysis of ferritin level with that of inflammatory cytokines including IL-8, IL-10, TNF-α and CRP. A. Ferritin vs. IL-8; B. Ferritin vs. IL-10; C. Ferritin vs. CRP; D. Ferritin vs. TNF-α. Pearson correlation was used. IL-8/10 indicates interleukin-8/10; TNF-α tumor necrosis factor-α; CRP C reactive protein.
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve analysis was performed for prediction of mortality by ferritin, PCT and CRP levels in patients with COVID-19 during hospitalization. The PCT (- - -) had AUC of 0.75 and 95% CI (0.65–0.85); CRP (— -) had AUC of 0.71 and 95% CI (0.61–0.82). The level of ferritin (——) has a better prognosis value (AUC = 0.82, 95% CI 0.74–0.91). *The cut-off points were selected by maximum Youden index with the sum of sensitivity and specificity. PCT indicates procaicltonin; CRP indicates C reactive protein.
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References

    1. Li H., Liu S.M., Yu X.H., Tang S.L., Tang C.K. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents. 2020;55:105951. doi: 10.1016/j.ijantimicag.2020.105951. - DOI - PMC - PubMed
    1. Jiang F., Deng L., Zhang L., Cai Y., Cheung C.W., Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19) J Gen Intern Med. 2020;35:1545–1549. doi: 10.1007/s11606-020-05762-w. - DOI - PMC - PubMed
    1. Madabhavi I., Sarkar M., Kadakol N. COVID-19: a review. Monaldi Arch Chest Dis. 2020:90. doi: 10.4081/monaldi.2020.1298. - DOI - PubMed
    1. Soy M., Keser G., Atagunduz P., Tabak F., Atagunduz I., Kayhan S. Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol. 2020;39:2085–2094. doi: 10.1007/s10067-020-05190-5. - DOI - PMC - PubMed
    1. Ruscitti P., Berardicurti O., Barile A., Cipriani P., Shoenfeld Y., Iagnocco A., et al. Severe COVID-19 and related hyperferritinaemia: more than an innocent bystander? Ann Rheum Dis. 2020 doi: 10.1136/annrheumdis-2020-217618. - DOI - PubMed

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