Hyperferritinemia, Low Circulating Iron and Elevated Hepcidin May Negatively Impact Outcome in COVID-19 Patients: A Pilot Study

Abstract

Inflammation in COVID-19 produces intracellular iron overload with low circulating iron available for metabolic processes. The accumulated intracellular iron generates reactive species of oxygen and results in ferroptosis, a non-programmed cell death. Since no organ is spared, iron dysmetabolism increases the mortality and morbidity. Hepcidin and the mediator interleukin 6 are believed to play a role in the process. Our aim is to evaluate the predictive values of serologic iron and inflammatory parameters in COVID-19 critically ill patients. Hence, 24 patients were included. Hepcidin and interleukin 6, along with routine blood parameters, were determined and outcomes, such as death, multiple organ damage (MOD), anemia, and need for transfusions, were assessed. The results of this pilot study indicate that iron metabolism parameters individually, as well as models consisting of multiple laboratory and clinical variables, may predict the outcomes. Further larger studies are needed to validate the results of this pilot stud. However, this paper identifies a new direction for research.

Keywords: COVID-19; anemia; ferritin; ferroptosis; hepcidin; inflammation; interleukin 6; iron overload; oxidative stress.

Figure 1

Flow diagram with numbers of patients assessed for eligibility, recruited, excluded, and analyzed.

Figure 2

Predictive value of serologic iron (A) and inflammatory (B) parameters to identify non survivors, patients who developed MOD and LA. IL 6 = interleukin 6; CRP = C reactive protein; MOD = multiple organ dysfunction.