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Clinical Trial
. 2022 Mar;101(3):513-520.
doi: 10.1007/s00277-021-04735-1. Epub 2021 Dec 4.

Hemophagocytosis, hyper-inflammatory responses, and multiple organ damages in COVID-19-associated hyperferritinemia

Guiying Dong  1   2 , Jianbo Yu  2 , Weibo Gao  2 , Wei Guo  1 , Jihong Zhu  3 , Tianbing Wang  4
Affiliations
Clinical Trial

Hemophagocytosis, hyper-inflammatory responses, and multiple organ damages in COVID-19-associated hyperferritinemia

Guiying Dong et al. Ann Hematol. 2022 Mar.

Abstract

Hyperferritinemia comes to light frequently in general practice. However, the characteristics of COVID-19-associated hyperferritinemia and the relationship with the prognosis were not well described. The retrospective study included 268 documented COVID-19 patients. They were divided into the hyperferritinemia group (≥ 500 µg/L) and the non-hyperferritinemia group (< 500 µg/L). The prevalence of fever and thrombocytopenia and the proportion of patients with mechanical ventilator support and in-hospital death were much higher in the hyperferritinemia group (P < 0.001). The hyperferritinemia patients showed higher median IL-6, D-dimer, and hsCRP (P < 0.001) and lowered FIB level (P = 0.036). The hyperferritinemia group had a higher proportion of patients with AKI, ARDS, and CSAC (P < 0.001). According to the multivariate analysis, age, chronic pulmonary disease, and hyperferritinemia were found to be significant independent predictors for in-hospital mortality [HR 1.041 (95% CI 1.015-1.068), P = 0.002; HR 0.427 (95% CI 0.206-0.882), P = 0.022; HR 6.176 (95% CI 2.447-15.587), P < 0.001, respectively]. The AUROC curve was 0.88, with a cut-off value of ≥ 971 µg/L. COVID-19 patients with hyperferritinemia had a high proportion of organ dysfunction, were more likely to show hyper-inflammation, progressed to hemophagocytic lymphohistiocytosis, and indicated a higher proportion of death.

Keywords: COVID-19; Hemophagocytic lymphohistiocytosis; Hyperferritinemia; In-hospital mortality.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of enrollment of study population
Fig. 2
Fig. 2
Inflammatory findings in the two groups
Fig. 3
Fig. 3
Spectrum of complications. AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; CSAC, cardiovascular sequelae associated with COVID-19; MODS, multiple organ dysfunction syndromes
Fig. 4
Fig. 4
Cumulative survival according to serum ferritin level
Fig. 5
Fig. 5
ROC curves of the serum ferritin level for predicting the in-hospital mortality
See this image and copyright information in PMC

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