Abstract
BackgroundFerritin even though widely recognized as a representative of total body iron stores, its prognostic utility is linked with COVID-19. This study was aimed at evaluation of the association of ferritin with severity in Coronavirus disease 2019 (COVID-19), hospitalized patients and to test the hypothesis that it is an independent predictor of mortality. Material and methodsThis study was conducted at Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi. Medical records of all in-patients including both genders, and all age groups with documented COVID-19 from 1st March to 10th August 2020 were reviewed. The subjects were divided into two categories severe and non-severe COVID-19; and survivors and non-survivors. The details were recorded on a pre-structured performa. Between-group differences were tested using the Mann–Whitney's U-test. The receiver operating characteristic curve was plotted for ferritin with severity and mortality. A binary logistic regression was used to identify variables independently associated with mortality. The data was analyzed using Statistical Package for the Social Sciences (SPSS). ResultsA total of 336 in patients were reviewed as declared COVID-19 positive during the study duration, and 157 were included in the final analysis including 108 males and 49 females. Statistically significant difference in ferritin was found in the two categories based on severity and mortality. Binary logistic regression showed ferritin to be an independent predictor of all-cause mortality supplemented with an AUC of 0.69 on ROC analysis. ConclusionsSerum ferritin concentration is a promising predictor of mortality in COVID-19 cases.
Highlights
The novel coronavirus disease 2019 (COVID-19) that emerged in December 2019 in Wuhan (Hubei, China), has surprisingly occupied the entire globe overwhelmingly, with many countries experiencing the second wave [1]
This study was aimed at evaluation of the association of ferritin with severity in Coronavirus disease 2019 (COVID-19), hospitalized patients and to test the hypothesis that it is an independent predictor of mortality
Owing to the scarcity of literature on the role of ferritin, and the contrasting results demonstrated by various studies on the potential association with severity and mortality in context, this study was aimed at evaluation of the association of the biomarker with severity in a cohort of hospitalized cases with COVID-19 at a tertiary care referral center in Karachi, the metropolis hardest hit by the pandemic in Pakistan
Summary
The novel coronavirus disease 2019 (COVID-19) that emerged in December 2019 in Wuhan (Hubei, China), has surprisingly occupied the entire globe overwhelmingly, with many countries experiencing the second wave [1]. There was a dire need for early risk stratification systems and biomarkers to predict disease progression, to identify high-risk patients at an early stage of the infection [3,4,5] This can optimize management goals, and overcome the shortage of medical and material resources which was evident amidst this global emergency. The primary triggering event, associated with severity and mortality has been the inflammatory cytokine storm, characterized by abrupt and excess release of pro-inflammatory cytokines including inflammatory cytokines released by macrophages the interleukins IL-6, IL10, and tumor necrosis factor (TNF-α) [6] With this pivotal event of the pathophysiological mechanism in perspective, biochemical analysis of plasma inflammatory markers and positive acute phase reactants including ferritin could be useful for predicting the disease progression (http://creativecommons.org/licenses/by/4.0/). Conclusions: Serum ferritin concentration is a promising predictor of mortality in COVID-19 cases
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