Prognostic Significance of Serum Ferritin in Decompensated Cirrhosis: Insights from a Prospective Analysis.

Background/AimsSerum ferritin is a marker of acute phase reactions and iron storage. In addition, hematologic malignancies are associated with elevated serum ferritin levels. Other studies have suggested that ferritin is a surrogate for advanced disease and has an impact on relapse, because elevated serum ferritin predicts overall survival (OS) and relapse-free survival following autologous stem cell transplantation for lymphomas.MethodsWe studied 89 consecutive patients with newly diagnosed multiple myeloma to determine the value of serum ferritin in comparison with known prognostic factors.ResultsThe OS in the elevated serum ferritin group (≥300 ng/mL) was shorter than that in the normal serum ferritin group (<300 ng/mL, p<0.001) after a median follow-up of 25 months. In univariate analysis, elevated ferritin was correlated with poor survival in the patients (relative risk [RR], 2.588; 95% confidence interval [CI], 1.536 to 4.358; p<0.001). Furthermore, multivariate analysis showed that elevated serum ferritin was an independent predictor of mortality in patients with multiple myeloma (RR, 2.594; 95% CI, 1.403 to 4.797; p=0.002).ConclusionsThe serum ferritin can a prognostic parameter of survival as well as disease activity in patients with multiple myeloma.

Cirrhosis is a major cause of morbidity and mortality worldwide [1]. While serum ferritin is recognized as a marker of liver injury and inflammation, its prognostic value for cirrhosis-related complications is not well established. We investigated whether serum ferritin levels could predict complications in cirrhotic patients. In this retrospective observational cohort study, which included both descriptive and analytical components, serum ferritin levels were measured in adult cirrhotic patients admitted to the gastroenterology department of a University Hospital Center between March 2017 and March 2024. The normal reference range was defined as 22–275 ng/mL for men and 4.63–204 ng/mL for women. Patients were monitored for the occurrence of complications over a one-year period. Statistical analyses were performed to assess the association between serum ferritin levels and complications, and to determine whether elevated ferritin was an independent predictor of adverse outcomes. The study included 200 cirrhotic patients (111 females and 89 males) with a mean age of 58,06 ± 15.21 years (range: 19–95). The most common etiologies were metabolic-associated steatohepatitis (MASH) (49.7%) and viral hepatitis (19%). Serum ferritin levels were significantly higher in decompensated patients compared to compensated patients (173 ± 295.22 ng/mL vs. 121.32 ± 251.98 ng/mL). During one-year follow-up, 68.5% of patients with elevated ferritin levels developed complications, compared to 27.7% of those with normal ferritin levels. Serum ferritin levels were significantly higher in Child-Pugh B patients (424.9 ng/mL) compared to Child-Pugh A (74.8 ng/mL, p = 0.002). Receiver operating characteristic (ROC) curve analysis demonstrated that serum ferritin has moderate discriminative power in predicting the occurrence of complications in cirrhotic patients (AUC = 0.670). Elevated ferritin (≥ 45 ng/mL) was associated with a significantly increased risk of complications (p < 0.001). Multivariate analysis revealed the following predictors of hepatic decompensation: elevated serum ferritin (aOR 5.76, 95% CI 2.08–15.90, p = 0.001), hyponatremia (aOR 0.39, 95% CI 0.18–0.85, p = 0.017), and vitamin D deficiency (aOR 6.52, 95% CI 1.86–22.92, p = 0.003). These findings highlight the complex and multifactorial nature of hepatic decompensation and support the inclusion of serum ferritin in a comprehensive prognostic assessment. Elevated serum ferritin levels are independently associated with an increased risk of complications in cirrhotic patients. Given its wide availability and low cost, serum ferritin may serve as a simple prognostic biomarker to guide risk assessment and optimize clinical management in this population.

Ferritin in decompensated cirrhosis: Iron or inflammation?

Introduction: Elevations in serum ferritin and serum iron occur during pediatric extracorporeal membrane oxygenation (ECMO). Previous reports attribute the elevation to frequent red blood cell transfusions and/or hemolysis. Chronic transfusion can cause iron deposition in tissues leading to multisystem organ dysfunction. This study aims identify clinical factors associated with elevated ferritin and iron in pediatric ECMO patients, along with post-decannulation magnetic resonance imaging (MRI) assessment of iron deposition in liver and brain.Methods: Prospective, pilot study, using descriptive statistics to investigate potential associations between patient characteristics, serum ferritin and iron levels, and post-decannulation hepatic and basal ganglia iron deposition.Results: In this study, nine patients (100%) had elevated serum ferritin levels during ECMO. High ferritin levels were more common with veno-arterial than with veno-venous cannulation (p = 0.026) and were also associated with high plasma free hemoglobin levels (p < 0.001). Five patients presented with elevated serum iron levels. High serum iron levels were associated with higher daily (p = 0.016) and cumulative transfusion volumes (p = 0.013) as well ECMO duration beyond 7days. MRI scans were performed on three patients with no evidence of abnormal iron deposition detected in the liver or brain.Conclusions: This pilot study shows that during pediatric ECMO, elevations in serum ferritin and serum iron occur and those elevations may be related to the cannulation modality, ECMO duration, amount of hemolysis, and volume of red blood cell transfusions. Further investigation is warranted to fully understand the implications of elevated serum iron and ferritin in pediatric ECMO.

Invasive mold infections (IMI) are life-threatening complications of allogeneic hematopoietic stem cell transplantation (HSCT) and are mostly caused by Aspergillus species and Mucorales. We examined whether elevated serum ferritin prior to HSCT was associated with increased risk of IMI after allogeneic HSCT. Elevated serum ferritin was defined as values ≥ 1000 ng/mL. Pretransplant ferritin levels were available for 477 transplants. Nine developed IMI at day 30 and 21 had IMI at day 100 for a cumulative incidence of 1.9% and 4.4%, respectively. Among the high ferritin group, eight of 220 transplant cases (3.6%) developed an IMI within 30 d after HSCT compared with one of 257 (0.4%) in the low ferritin group (P = 0.01). Fourteen of 220 (6.4%) and seven of 257 transplant cases (2.7%) in the high and low ferritin groups, respectively, had developed an IMI by day 100 after HSCT (P = 0.07). Nine of 53 (17%) patients with grades III and IV acute GVHD and iron overload experienced IMI, when compared to three of 37 (8.1%) with high-grade aGVHD, but no iron overload. Among patients without aGVHD, those with elevated ferritin had a 2.7% incidence of IMI compared with 0.9% for patients without elevated ferritin. There was a marginally significant difference in cumulative incidence function between high and low ferritin groups for IMI (P = 0.06). However, elevated serum ferritin (≥ 1000 ng/mL) was not a significant risk factor for IMI in a multivariate competing risk regression model after adjusting for aGVHD.

Neutrophil Gelatinase–associated Lipocalin Predicts Short-term Outcomes in Decompensated Cirrhosis With Acute Kidney Injury

Prognostic Impact of Elevated Serum Ferritin at Diagnosis of Diffuse Large B-Cell Lymphoma Treated In the Rituximab Era

Predictive performance of distinct skeletal muscle index cut-offs-defined sarcopenia for long-term mortality in decompensated cirrhosis: A prospective observational study.

The (II)logic of iron reduction therapy for steatohepatitis.

Introduction: Ferritin is an acute phase reactant commonly elevated in response to infections, inflammation, liver disease, and malignancy. However, the significance of persistently elevated serum ferritin levels in lung transplant patients is poorly understood. In this case series, we present our experience with elevated ferritin levels in 3 lung transplant recipients. Case Descriptions: We report three patients who underwent bilateral lung transplantation at our center, with a median age of 67 years. After transplant, all patients displayed persistently elevated serum ferritin levels, with a median of 988 µg/L, peaking at 6147 µg/L. Indications for lung transplant included chronic obstructive pulmonary disease, pulmonary fibrosis, and combined pulmonary fibrosis and emphysema. Patient 1 experienced a progressive increase in ferritin levels (266-6174 µg/L) and required 14 hospital admissions for pneumonia, pleural effusion, and infections with Streptococcus anginosus, Aspergillus, and Pseudomonas. Patient 2, who had the highest recorded ferritin level of 9228 µg/L, was diagnosed before transplant with myelodysplastic syndrome that progressed to acute myeloid leukemia 10 months after transplant. This patient died one year after transplant and had persistent Staphylococcus aureus bacteremia and pneumonia. Patient 3 had an elevated pretransplant ferritin level of 1890 µg/L, which remained high after transplant at 1468 µg/L. Notably, this patient has not required hospital readmission since their transplant in February 2024 and continues to be closely monitored. Discussion: Our cases highlight a novel finding: persistently elevated ferritin levels without an identifiable cause in lung transplant recipients. Ferritin is a known marker of inflammation, and ferritin levels and transferrin saturation are predictors of body iron stores. Iron overload has a significant role in the pathogenesis of various infections through free radical-induced tissue damage. Elevated ferritin levels have been associated with a higher risk of morbidity and mortality after stem cell transplantation, and with worse outcomes in patients with hematological or lung malignancies. However, its significance in this immunocompromised transplant population remains unclear and may extend beyond infection or iron overload. We hypothesize that elevated ferritin in these patients may reflect a complex immunological or metabolic response to transplantation. This is the first report to explore the significance of elevated ferritin and its prognostic implications in transplant patients. We suggest that serum ferritin be measured in routine clinical evaluation and follow-up of lung transplant recipients, and high levels should prompt further investigations for underlying pathology.

Elevated Ferritin Predicts for Inferior Survival in Patients with Acute Leukemia and May be an Early Marker of a Underlying Systemic Pathologic Inflammation

This study analysed the influence of extrinsic factors on the phenotypic expression of HFE gene variants in ethnic Danish men. A cohort of 6,020 men aged 30-53 years was screened for HFE C282Y, H63D and S65C variants. Serum iron, serum transferrin, transferrin saturation, and serum ferritin were analysed in 1,452 men and 1,294 men completed a questionnaire on factors, which could influence iron balance. The C282Y allele was present in 5.6%, H63D in 12.8% and S65C in 1.8% of the men. In the entire series, 3% had elevated iron status markers (transferrin saturation > or =50%, ferritin > or =300 microg/L). Self-reported liver disease had an elevating effect and peptic ulcer a lowering effect on iron status markers. Age increased the fraction of men with elevated ferritin from 8.3% at 32-38 years to 16.2% at 46-53 years of age (p = 0.002). Blood donation had a lowering effect on iron status markers (p = 0.0001). Alcohol consumption elevated serum iron and serum ferritin (p = 0.001). Meat consumption had an elevating effect (p = 0.02) and milk consumption a lowering effect (p = 0.03) on serum ferritin. There was no influence of vitamin-mineral tablets on iron status markers. In adjusted logistic regression analysis, the HFE genotype had the highest impact on iron status markers; high alcohol consumption was significantly associated with elevated transferrin saturation. High age and high alcohol consumption were significantly associated with elevated ferritin and high egg consumption and blood donation was significantly associated with normal ferritin levels. In conclusion, the expressivity of HFE variant phenotypes in Danish men was enhanced by alcohol and meat consumption and decreased by milk and egg consumption and blood donation.

Prognostic Impact of Elevated Pretransplant Serum Ferritin in Allogeneic Hematopoietic Stem Cell Transplantation.

Significant Suppression of the Colony Forming Capacity of Erythroid Progenitors by Iron Overload in Patients with MDS and Sequential Anlyses of BFU-E Under Chelation Therapy.

Optimizing Iron Overload Screening in a Pediatric Center for Cancer and Blood Disorders