Abstract
BackgroundIron, an essential mineral for human body, has the potential to cause toxicity at high levels. Previous studies have shown inconsistent predictive value of iron parameters in critically ill patients. Thus, we aimed to evaluate the performance of iron parameters in outcome prediction of neurocritically ill patients.MethodsRetrospective data were collected from patients admitted to the neurocritical care unit (NCU) of a tertiary teaching hospital between August 2016 and January 2017. The iron parameters were obtained at NCU admission. Primary endpoints were short‐term (30‐day) mortality and long‐term (6‐month) poor outcome, with the latter defined as modified Rankin Scale of 4–6. The predictive value of variables was determined with univariate and multivariate logistic analysis. A further subanalysis was conducted in patients stratified by the level of estimated glomerular filtration rate (eGFR).ResultsOf 103 eligible patients, the etiology included stroke (58.2%, N = 60), central nervous system infection (13.6%, N = 14), and other neurologic disorders (28.2%, N = 29). The correlation analysis showed that the increase in ferritin, as well as the reduction in transferrin and total iron‐binding capacity, had strong correlation with C‐reactive protein, procalcitonin, duration of NCU stay, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score. In a further subanalysis of 75 patients with eGFR ≥ 60 ml/min/1.73 m2, twelve (16.0%) patients died within 30 days and 39 (52.0%) patients achieved good follow‐up outcome data. In the multivariate logistic regression analysis, we identified baseline ferritin level as an independent predictor of short‐term mortality (OR: 1.002; 95% CI: 1.000–1.003; p = 0.008) and long‐term functional outcome (OR: 1.002; 95% CI: 1.000–1.004; p = 0.031).ConclusionsSerum ferritin level at admission could be used as an independent predictor of short‐term mortality and long‐term functional outcome in neurocritically ill patients with eGFR ≥ 60 ml/min/1.73 m2.
Highlights
Iron has many different roles in the body, acting in carrying oxygen, delivering electron, and catalyzing many biochemistry reactions
In multivariate logis‐ tic analysis, ferritin was independently associated with 30‐day mor‐ tality (OR: 1.002; 95% CI: 1.000–1.003; p = 0.008) (Table 3)
Increased Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, length of neuro‐ critical care unit (NCU) stay, and serum C‐reactive protein levels were observed in patients with poor functional outcome at 6 months compared to those with good func‐ tional outcome (39 patients), while there were no differences in any iron parameters (Supporting information Table S1)
Summary
Iron has many different roles in the body, acting in carrying oxygen, delivering electron, and catalyzing many biochemistry reactions. The non‐trans‐ ferrin‐bound iron is toxic because it can generate free radicals via participating in the Fenton/Haber–Weiss reaction. These reactive oxidative species could cause lipid peroxidation and bring dam‐ ages to proteins and DNA (Brissot, Ropert, Le Lan, & Loreal, 2012; Koskenkorva‐Frank, Weiss, Koppenol, & Burckhardt, 2013). Iron me‐ tabolism disturbance occurs frequently in intensive care unit (ICU) patients, whereby some of the iron parameters reported to be useful in predicting the prognosis of these patients. These studies are mainly performed in surgical or general ICU. We performed this study to evaluate the predictive value of iron parameters in neurocritically ill subjects
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