Abstract
Hyperferritinemia comes to light frequently in general practice. However, the characteristics of COVID-19-associated hyperferritinemia and the relationship with the prognosis were not well described. The retrospective study included 268 documented COVID-19 patients. They were divided into the hyperferritinemia group (≥ 500 µg/L) and the non-hyperferritinemia group (< 500 µg/L). The prevalence of fever and thrombocytopenia and the proportion of patients with mechanical ventilator support and in-hospital death were much higher in the hyperferritinemia group (P < 0.001). The hyperferritinemia patients showed higher median IL-6, D-dimer, and hsCRP (P < 0.001) and lowered FIB level (P = 0.036). The hyperferritinemia group had a higher proportion of patients with AKI, ARDS, and CSAC (P < 0.001). According to the multivariate analysis, age, chronic pulmonary disease, and hyperferritinemia were found to be significant independent predictors for in-hospital mortality [HR 1.041 (95% CI 1.015–1.068), P = 0.002; HR 0.427 (95% CI 0.206–0.882), P = 0.022; HR 6.176 (95% CI 2.447–15.587), P < 0.001, respectively]. The AUROC curve was 0.88, with a cut-off value of ≥ 971 µg/L. COVID-19 patients with hyperferritinemia had a high proportion of organ dysfunction, were more likely to show hyper-inflammation, progressed to hemophagocytic lymphohistiocytosis, and indicated a higher proportion of death.
Highlights
COVID-19 caused by SARS-CoV-2 has become a pandemic worldwide [1, 2]
The hyperferritinemia patients comprised 94 males (65.28%) with an average of 67 years (IQR 57–73), which is consistent with the previous COVID-19 research results [2, 24]; our study further confirmed this phenomenon
Our study further compared the difference between hyperferritinemia patients and nonhyperferritinemia patients
Summary
COVID-19 caused by SARS-CoV-2 has become a pandemic worldwide [1, 2]. Serum ferritin levels typically reflect total body iron stores and identify patients with iron overload syndromes or iron deficiency. There is growing evidence that severe COVID-19, characterized by cytokine storm syndrome (CSS), can lead to acute respiratory distress syndrome (ARDS), as well as extrapulmonary multiple organ dysfunction, even death. Some scholars deduced that severe COVID-19 correlated with the “hyperferritinemic syndrome” [6,7,8,9], in which conditions, ferritin levels do reflect an acute inflammatory process response but rather may have a pathogenic role [5]. MAS is the alternative name for acquired hemophagocytic lymphohistiocytosis (HLH), with the clinical presentations including fever and splenomegaly, as well
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