Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that leads to severe respiratory failure (RF). It is known that host exposure to viral infection triggers an iron-lowering response to mitigate pathogenic load and tissue damage. However, the association between host iron-lowering response and COVID-19 severity is not clear. This two-center observational study of 136 adult hospitalized COVID-19 patients analyzed the association between disease severity and initial serum iron, total iron-binding capacity (TIBC), and transferrin saturation (TSAT) levels. Serum iron levels were significantly lower in patients with mild RF than in the non-RF group; however, there were no significant differences in iron levels between the non-RF and severe RF groups, depicting a U-shaped association between serum iron levels and disease severity. TIBC levels decreased significantly with increasing severity; consequently, TSAT was significantly higher in patients with severe RF than in other patients. Multivariate analysis including only patients with RF adjusted for age and sex demonstrated that higher serum iron and TSAT levels were independently associated with the development of severe RF, indicating that inadequate response to lower serum iron might be an exacerbating factor for COVID-19.
Highlights
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that leads to severe respiratory failure (RF)
Patient outcomes were classified into three categories according to their worst respiratory status during hospitalization as follows: non-respiratory failure, not requiring oxygen therapy or mechanical ventilation (MV) throughout hospitalization; mild RF, requiring oxygen therapy or MV but with the worst arterial oxygen partial pressure/fractional inspired oxygen (P/F) ratio measured with MV or high-flow nasal oxygen therapy (HFNO) maintained above 200; severe RF, the worst P/F ratio measured with MV or HFNO ≤ 200
One hundred thirty-six patients were included in the study among 204 patients with COVID-19 admitted to Yokohama City University Hospital (YCUH) (59 patients) or Yokohama Municipal Citizen’s Hospital (YMCH) (77 patients) (Fig. 1)
Summary
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that leads to severe respiratory failure (RF). It is known that host exposure to viral infection triggers an iron-lowering response to mitigate pathogenic load and tissue damage. The association between host iron-lowering response and COVID-19 severity is not clear. This two-center observational study of 136 adult hospitalized COVID-19 patients analyzed the association between disease severity and initial serum iron, total iron-binding capacity (TIBC), and transferrin saturation (TSAT) levels. Abbreviations ARDS Acute respiratory distress syndrome COVID-19 Coronavirus disease 2019 HFNO High-flow nasal oxygen therapy IQR Interquartile range MV Mechanical ventilation P/F ratio Arterial oxygen partial pressure/fractional inspired oxygen ratio RF Respiratory failure SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 TIBC Total iron binding capacity TSAT Transferrin saturation YCUH Yokohama City University Hospital YMCH Yokohama Municipal Citizen’s Hospital. It has been reported that high serum iron level is associated with worse mortality in patients with sepsis
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