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Inicio Medicina Clínica (English Edition) Increased levels of ferritin on admission predicts intensive care unit mortality...
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Vol. 156. Issue 7.
Pages 324-331 (April 2021)
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Vol. 156. Issue 7.
Pages 324-331 (April 2021)
Original Article
DOI: 10.1016/j.medcle.2020.11.015
Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19
El incremento de ferritina sérica durante el ingreso predice la mortalidad de los pacientes de COVID-19 en Cuidados Intensivos
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Fuxue Denga,1, Lisha Zhanga,1, Lyu Lyua, Ziwei Lua, Dengfeng Gaoa, Xiaorong Mab, Yonghong Guoc, Rong Wanga, Shouping Gongd,2,
Corresponding author
lecross@163.com

Corresponding authors.
, Wei Jianga,2,
Corresponding author
xnkjiangwei@163.com

Corresponding authors.
a Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710004, China
b Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710004, China
c Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710004, China
d Department of Neurosurgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710004, China
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Tables (4)
Table 1. Clinical characteristics and laboratory results in patients with COVID-19.
Table 2. Comparison of the clinical information and laboratory results in patients with COVID-19 depending on in-hospital outcomes.
Table 3. Comparison of the clinical information and laboratory results in patients with COVID-19 depending on classification of ferritin level.
Table 4. Logistic regression for the relationship between ferritin and in-hospital mortality in patients with COVID-19.
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Abstract
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.

Keywords:
COVID-19
SARS-CoV-2
Ferritin
Inflammation markers
Mortality
Abbreviations:
COVID-19
ICU
ARDS
MOF
HP
DM
CHD
SARS
MERS
IL
TNF
MAS
AOSD
CAPS
RT-PCR
PaO2
RR
FiO2
IQR
ROC
PCT
CRP
AUC
SBP
DBP
HR
SpO2
WBC
RBC
PT
PTA
INR
APTT
TT
Hs-TnI
CK-MB
NT-proBNP
ALT
AST
BUN
eGFR
MV
Resumen
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 (1.722,25μg/L vs. 501,90μg/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.

Palabras clave:
COVID-19
SARS-CoV-2
Ferritina
Marcadores inflamatorios
Mortalidad

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