Relationship between iron homeostasis and prognosis in patients with heart failure: a retrospective study based on the MIMIC-IV database

Abstract

Introduction: The role of iron homeostasis has become increasingly recognized as a key factor in determining a prognosis of patients with heart failure (HF). Disruptions in iron balance, encompassing deficiency and overload, can affect patient prognosis, and therefore, significantly impact treatment and management strategies.

Objectives: The study investigated possible associations between iron homeostasis-related indicators and long‑term mortality as well as first‑admission mortality in individuals with HF.

Patients and methods: Data on 3483 HF patients from the MIMIC‑IV database were retrospectively analyzed. The relationship between iron homeostasis-related indicators (ferritin, serum iron, transferrin, and total iron binding capacity [TIBC]) and the first-admission and long-term mortality of HF patients was discerned utilizing the Cox proportional hazards model and the Kaplan-Meier survival analysis. Additionally, the predictive capability of these indicators for patient prognosis was assessed using the receiver operating characteristic curve.

Results: Fourth quartile levels of ferritin and serum iron were obviously associated with poor long‑term outcomes in HF patients. Conversely, fourth quartile levels of transferrin and TIBC served as protective factors and were associated with a lower mortality. Additionally, iron homeostasis indicators exhibited a certain predictive value for both long‑term mortality and first‑admission mortality in HF patients.

Conclusions: This study underscores a significant association between iron homeostasis indicators and the prognosis of HF patients, providing valuable insights into risk stratification and clinical decision‑making for this population. Future studies should focus on dynamic fluctuations in iron homeostasis and explore interventions to improve the prognosis of HF patients.