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. 2025 May 2;25(1):331.
doi: 10.1186/s12876-025-03891-2.

A clinical predictive score of high liver iron content in metabolic hyperferritinemia: a retrospective cohort pilot study

Mohamed Lotfi Boughzala  1 , Bruno Pereira  2 , Marc Ruivard  1   3 , Hervé Lobbes  4   5
Affiliations

A clinical predictive score of high liver iron content in metabolic hyperferritinemia: a retrospective cohort pilot study

Mohamed Lotfi Boughzala et al. BMC Gastroenterol. .

Abstract

Background: In metabolic hyperferritinemia, most patients do not require bloodletting as the liver iron content is mildly increased. We aimed to develop a clinical predictive score of high liver iron content in metabolic hyperferritinemia to guide the prescription of magnetic resonance imaging of the liver.

Methods: We conducted a single-center retrospective cohort study including consecutive patients with metabolic hyperferritinemia who underwent a liver iron content evaluation at diagnosis. Excessive alcohol consumption was an exclusion criterion. A multivariate analysis followed by a 1000 bootstrap replicate analysis with an expectation-maximization algorithm was used to identify the predictive factors of high liver iron content. A ROC curve analysis was built to study the performance of the score based on the odds-ratio provided by the multivariate analysis.

Results: 217 patients (180 men, mean age 57 years old) were included. Fifty-five patients (25%) had high liver iron content (≥ 100 µmol/g). In univariate analysis, a family history of hyperferritinemia requiring phlebotomies was associated with high LIC, as well as an increase of transferrin saturation > 45% (p < 0.001). In multivariate regression, a family history of hyperferritinemia (OR 6.15, CI95 [2.11-17.92]), increased ferritin level ≥ 600 µg/L (OR 5.53, CI95 [1.43-21.42]) and increased transferrin saturation ≥ 45% (OR 2.63, CI95 [1.32-5.23]) were significantly associated with high liver iron content. A 15-point predictive score (area-under-the-curve 0.72, CI95 [0.64-0.79], p < 0.001) was built, providing an OR of 4.17 (CI95 [2.15-8.07], p < 0.001) for high liver iron content (sensitivity 60%, specificity 97%, negative predictive value 84%).

Conclusion: in this pilot study, ferritin ≥ 600 µg/L, transferrin saturation ≥ 45% and a family history of hyperferritinemia requiring bloodletting provided a simple clinical score to predict high liver iron content in metabolic adult hyperferritinemia. The bootstrap analysis confirmed the robustness of our model.

Keywords: Liver iron content; Magnetic resonance imaging; Metabolic hyperferritinemia; Predictive score..

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice recommendations, and approved by the local Ethics Committee who waived the need for informed consent (International Review Board 00013412, “CHU de Clermont-Ferrand IRB #1”, IRB number 2023-CF029) with compliance with the French policy of individual data information and protection. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
receiver operative curve of predictive high liver iron content score AUC: area under the curve ROC: receiver operative curve
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References

    1. Ganz T. Systemic Iron homeostasis. Physiol Rev. 2013;93:1721–41. - PubMed
    1. Brissot P, Ropert M, Le Lan C, Lor_eal O. Non-transferrin bound iron: a key role in iron overload and iron toxicity. Biochim Biophys Acta. 2012;1820:403–10. - PubMed
    1. Deugnier Y, Lainé F, Jézéquel C, Bonnet F. Steatohepatitis, iron overload and insulin resistance. Médecine Mal Métaboliques 2012:117:1155–63.
    1. Roblin X, Chevassus P, Boudemaghe T, Paladoyan A. L’Hépatosidérose dysmétabolique doit-elle être recherchée systématiquement Au cours du diabète de type II? Diabetes Metab 2002:4:335–9. - PubMed
    1. Adams PC, et al. Hemochromatosis and iron-overload screening in a Racially diverse population. N Engl J Med. 2005;17:1769–78. Hemochromatosis and Iron Overload Screening (HEIRS) Study Research Investigators. - PubMed

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