Abstract
Iron deficiency (ID) in patients with chronic inflammatory diseases is frequent. However, under-diagnosis is also frequent due to the heterogeneity between guidelines from different medical societies. We applied a common definition for the diagnosis of ID to a large panel of patients with cancer, heart failure (HF), inflammatory bowel disease (IBD), and chronic kidney disease (CKD), where ID was defined as serum ferritin concentration <100 μg/L and/or a transferrin saturation (TSAT) index <20%. Prevalence estimates using this common definition were compared with that obtained with officially accepted definitions (ESMO 2018, ESC 2016, ECCO 2015, and ERBP 2013). For that purpose, we used data collected during the French CARENFER studies, which included 1232, 1733, 1090, and 1245 patients with cancer, HF, IBD, and CKD, respectively. When applying the common definition, ID prevalence increased to 58.1% (vs. 57.9%), 62.8% (49.6%), and 61.2% (23.7%) in cancer, HF, and IBD patients, respectively. Both prevalence estimates were similar (47.1%) in CKD patients. Based on our results, we recommend combining both ferritin concentration and TSAT index to define ID in patients with chronic inflammatory diseases. In those patients, adopting this common definition of ID should contribute to a better screening for ID, whatever the condition.
Highlights
Iron deficiency (ID) is the most common and widespread deficiency in the world, with more than 1.2 billion affected individuals with anemia, and probably more than double that without anemia [1]
A total of 1232, 1733, 1090, and 1245 patients with cancer, heart failure (HF), inflammatory bowel disease (IBD), and chronic kidney disease (CKD) were included between 9 May 2019 and 29 June 2021, respectively
Some laboratory markers of iron status might be available for ID diagnosis, it is well established that transferrin saturation (TSAT) index is the most specific marker that correlates with the reduction of the total serum iron availability in chronic inflammatory conditions [5]
Summary
Iron deficiency (ID) is the most common and widespread deficiency in the world, with more than 1.2 billion affected individuals with anemia, and probably more than double that without anemia [1]. In patients with chronic inflammatory diseases, ID is mainly the consequence of a disturbed iron homeostasis due to the release of inflammatory cytokines [4]. In this case, ID is called functional ID as it results from the sequestration of iron in otherwise quantitatively normal or abundant stores. ID can be due to an insufficient iron intake or absorption or chronic blood loss, leading to a decrease in the total iron supply in the body. This quantitative decrease in iron stores defines absolute ID. In chronic inflammatory diseases, these two types of ID are not mutually exclusive and are often associated [5]
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