Abstract
BackgroundIron deficiency (ID) and anemia are common in both heart failure (HF) and cancer patients and are associated with poor quality of life and survival. The aims of this study were (1) to evaluate the prevalence, types, and confounding factors of ID and anemia in patients referred to cardio-oncology clinic, and (2) identify the association between iron metabolism parameters and survival of cardio-oncology patients.MethodsWe assessed iron, ferritin, hemoglobin concentrations, transferrin saturation (TSAT), cancer type, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), kidney function, cardiovascular risk factors and survival in 599 patients who were referred to cardio-oncology clinic from 2011 to 2017.ID was defined by a TSAT < 20%, absolute iron deficiency (AID) with a serum ferritin level < 100 μg/L while serum ferritin level of ≥ 100 μg/L was considered as functional iron deficiency (FID) and TSAT ≥ 20% was considered as no ID.ResultsThe prevalence of ID, AID, and FID was 46, 31, and 15% of study patients, respectively. Anemia was present in approximately half (54%) of the patients with any ID.Multivariate Cox analyses showed that male gender (HR 1.704 [1.207–2.404] p = 0.002); previous cancer history (HR 1.879 [1.079–3.272] p = 0.026); elevated BNP (HR 2.126 [1.258–3.590] p = 0.005); TSAT< 20% (HR 1.721 [1.214–2.439] p = 0.002); ferritin ≥ 100 μg/L (HR 2.008 [1.088–3.706] p = 0.026); serum iron concentration < 12 μmol/L (HR 2.292 [1.614–3.255] p < 0.001); FID (HR 2.538 [1.1618–3.981] p < 0.001) and anemia (HR 2.462 [1.734–3.495] p < 0.001) were significantly associated with increased risk of all-cause death.ConclusionsAbout half of cardio-oncology patients had anemia and iron deficiency, with the absolute type being twice as prevalent as the functional one. Patients with breast, gastrointestinal, and genitourinary cancer were affected more often. Both anemia and iron deficiency independently predicted all-cause mortality. Future studies are required to confirm ID as a risk factor and evaluate the clinical benefits of iron replacement therapy.
Highlights
Iron homeostasis Iron is a fundamental element of the human body that is responsible for energy metabolism, oxygen transport and exchange, electron transfer, Deoxyribonucleic acid (DNA) synthesis and repair, cell growth, and proliferation [1].Iron circulates in plasma bound to the glycoprotein transferrin, which sustains iron in a soluble form, shielding iron from developing of toxic radicals and via transferrin receptors delivers it into cells [2].Under normal conditions, serum ferritin reflects the iron stores’ status, which correlates with the iron amount in liver biopsy samples
Confounding factors of Iron deficiency (ID) In univariate analyses gender, cancer location, elevated brain natriuretic peptide (BNP) value, Diabetes mellitus (DM), kidney dysfunction, and anemia were associated with an ID
In multivariate analysis taking into account all these parameters except elevated BNP and other cancer locations than breast, absolute iron deficiency (AID) was independently associated with female gender, anemia, DM, whereas functional iron deficiency (FID) – with breast cancer and anemia
Summary
Iron homeostasis Iron is a fundamental element of the human body that is responsible for energy metabolism, oxygen transport and exchange, electron transfer, DNA synthesis and repair, cell growth, and proliferation [1].Iron circulates in plasma bound to the glycoprotein transferrin, which sustains iron in a soluble form, shielding iron from developing of toxic radicals and via transferrin receptors delivers it into cells [2].Under normal conditions, serum ferritin reflects the iron stores’ status, which correlates with the iron amount in liver biopsy samples. Iron deficiency in patients with cancer Iron metabolism and regulation of homeostasis are often altered in patients with cancer. It is associated with the status of chronic disease, chronic blood loss, and nutritional deficiencies [4]. The aims of this study were (1) to evaluate the prevalence, types, and confounding factors of ID and anemia in patients referred to cardio-oncology clinic, and (2) identify the association between iron metabolism parameters and survival of cardio-oncology patients. This study’s aims were (1) to evaluate the prevalence, types, and confounding factors of ID and anemia in patients referred to cardio-oncology clinic, and (2) identify the association between iron metabolism parameters and survival of cardio-oncology patients
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