Abstract
BackgroundBoth iron overload and iron deficient anemia can associate with cirrhosis. At the same time, inflammation might be continuously present in cirrhotic patients due to bacterial translocation and patients’ susceptibility to infections. Ferritin is a sensitive and widely available marker of iron homeostasis, in addition it acts as an acute phase protein. Therefore, we evaluated the prognostic potential of serum ferritin in the long-term follow-up of cirrhotic outpatients.MethodsA cohort of 244 cirrhotic outpatients was recruited and followed for 2 years. We measured their serum ferritin levels in our routine laboratory unit at enrolment and investigated its association with clinical outcomes.ResultsFerritin serum level was higher in males and older patients than in females (median: 152.6 vs. 75 μg/L, p < 0.001) or younger individuals (median: 142.9 vs. 67.9 μg/L, p = 0.002). Patients who previously survived variceal bleeding had lower ferritin levels (median: 43.1 vs. 146.6 μg/L, p < 0.001). In multivariate regression models, including laboratory and clinical factors, lower (< 40 μg/L) ferritin concentration was associated with the development of decompensated clinical stage in patients with previously compensated cirrhosis (sHR: 3.762, CI 1.616–8.760, p = 0.002), while higher (> 310 μg/L) circulating ferritin levels were associated with increased risks of bacterial infections in decompensated patients (sHR: 2.335, CI 1.193–4.568, p = 0.013) and mortality in the whole population (HR: 2.143, CI 1.174–3.910, p = 0.013).ConclusionWe demonstrated usefulness of serum ferritin as a prognostic biomarker in cirrhosis, pointing out that both low and high concentrations need attention in these patients.
Highlights
Different metabolic and hematological abnormalities often associate with different chronic liver diseases
Increased ferritin levels were found in males compared to females, and in ≥ 50 years old patients compared to younger ones
We didn’t detect significant differences in serum ferritin levels between patients with or without ascites, in the absence or presence of HCC, and with alcoholic or non-alcoholic etiology (median [Interquartile range (IQR)]: (See figure on page.) Fig. 2 Serum ferritin levels according to different patient characteristics
Summary
Different metabolic and hematological abnormalities often associate with different chronic liver diseases. Both iron overload and iron deficient anemia are reported in patients with liver cirrhosis (LC) [1, 2]. Iron overload in LC seems to be due, at least in part, to reduced hepcidin levels caused by decreased synthetic capacity of hepatocytes. Decreased hepcidin concentration leads to increased iron uptake [3, 4]. Since cirrhosis is an immune suppressed condition, especially in the later Both iron overload and iron deficient anemia can associate with cirrhosis. Inflamma‐ tion might be continuously present in cirrhotic patients due to bacterial translocation and patients’ susceptibility to infections. We evaluated the prognostic potential of serum ferritin in the long-term follow-up of cirrhotic outpatients
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