Cut-off Value Of Serum Ferritin Research Articles

Serum ferritin and neutrophil-to-lymphocyte ratio predict all-cause mortality in patients receiving maintenance hemodialysis: a prospective study.

Introduction: Maintenance hemodialysis is an effective treatment for end-stage renal disease patients. A critical factor contributing to the deterioration and death of maintenance hemodialysis patients is inflammation. Therefore, we focused on two inflammatory markers, serum ferritin and neutrophil-to-lymphocyte ratio, to speculate whether they could predict the prognosis of maintenance hemodialysis patients. Patients and methods: We followed 168 patients with maintenance hemodialysis from July 2019 to July 2022 with the endpoint of all-cause death or follow-up completion. Receiver operating characteristic curves were plotted to assess the values of serum ferritin, neutrophil-to-lymphocyte ratio and serum ferritin combined with neutrophil-to-lymphocyte ratio to predict the outcomes of maintenance hemodialysis patients. Kaplan-Meier survival curves were constructed to compare survival rates over time. Results: Receiver operating characteristic curves demonstrated that the best cut-off value of serum ferritin for predicting the prognosis of maintenance hemodialysis patients was 346.05μg/L, and that of neutrophil-to-lymphocyte ratio was 3.225. Furthermore, a combination of both had a more excellent predicting value than either index (p < 0.05). Kaplan-Meier survival curve analyses revealed that low serum ferritin levels and low neutrophil-to-lymphocyte ratio had a higher probability of survival than high ferritin levels and high neutrophil-to-lymphocyte ratio, separately. Conclusion: Elevated serum ferritin and neutrophil-to-lymphocyte ratio are closely related to all-cause mortality among maintenance hemodialysis patients, for which they may be predictors of all-cause mortality. Additionally, the combination of the two has a much higher predictor value for the prognosis of maintenance hemodialysis patients.

Serum Ferritin as a Prognostic Marker in COVID-19

Abstract Background and Objectives: This study was conducted during the peak of COVID-19 disease with the objective to find the association of serum ferritin and COVID-19 disease severity, to evaluate the utility of serum ferritin as a prognostic marker in COVID-19, and to determine a cutoff value for serum ferritin as a prognostic marker for COVID-19. Materials and Methods: A retrospective study was conducted by the department of biochemistry, in collaboration with the department of medicine in a tertiary care center among 103 patients who were admitted with COVID-19 infection after fulfilling the eligibility criteria. Patients were grouped according to the disease severity and also on the outcome during hospitalization. Results: The serum ferritin level was found to be significantly higher in the severe and critical groups when compared to the mild and moderate groups. However, the difference was not significant between mild and moderate and also between severe and critical groups. The serum ferritin level was also significantly higher in those who did not survive when compared to those who survived. A cutoff value of 635.25 ng/ml was found to have 76% sensitivity and 90.5% specificity to identify patients with severe COVID-19 disease. A cutoff value of 760.65 ng/ml was able to predict mortality with 73.3% sensitivity and 84.1% specificity. Conclusion: Estimating serum ferritin levels in all COVID-19 patients can be beneficial in predicting the progress of the disease and hence aid in the selection of appropriate management.

Platelet and ferritin as early predictive factors for the development of macrophage activation syndrome in children with Kawasaki disease: A retrospective case-control study.

To investigate the early predictive factors for Kawasaki disease complicated with macrophage activation syndrome (KD-MAS). We performed a retrospective case-control study in children with KD from August 2017 to August 2022, involving 28 cases with KD-MAS and 112 cases not developing KD-MAS. Based on the univariate analysis, binary logistic regression was used to identify the early predictive factors for KD-MAS development, and the receiver operating characteristic curve (ROC) analysis was carried out to obtain the optimal cut-off value. Two predictive factors were associated with the development of KD-MAS, which were PLT (OR = 1.013, 95%CI, 1.001-1.026), and serum ferritin (OR = 0.991, 95%CI, 0.982-0.999). The cut-off value of PLT was 110 × 109/L, and the cut-off value of serum ferritin was 548.4 ng/ml. Children with KD who had a PLT count under 110 × 109/L, and a serum ferritin level over 548.4 ng/ml are more likely to develop KD-MAS.

Association of Serum Ferritin Level in Early Second Trimester of Pregnancy with Development of Gestational Diabetes Mellitus: A Prospective Observational Study.

Gestational diabetes mellitus (GDM) is associated with various maternal and perinatal morbidities. Serum ferritin is a major storage protein of iron and also acts as acute phase reactant which is increased in inflammatory conditions. GDM is a state of insulin resistance and associated with inflammation. The aim of this study was to find the correlation between serum ferritin and development of GDM. To determine the serum ferritin concentration in nonanemic pregnant women and its correlation with subsequent development of GDM. In this prospective observational study, 302 nonanemic pregnant women with singleton gestation between 14 and 20weeks, attending antenatal OPD, were enrolled. Serum ferritin was measured at the time of enrolment, and they were followed till 24-28weeks of gestation and subjected to blood glucose test by DIPSI method. A total of 92 women had blood glucose level ≥ 140mg/dl and were labeled as GDM, and 210 pregnant women with blood glucose level < 140mg/dl were labeled as non-GDM. Mean serum ferritin level of women with GDM (56.44 ± 19.19ng/ml) was found to be higher as compared to non-GDM (27.62 ± 12.11ng/ml), and this difference was found to be statistically significant (p < 0.001). The cutoff value of serum ferritin > 37.55ng/ml was found to be 85.9% sensitive and 81.9% specific. We can infer that serum ferritin is associated with development of GDM. Based on the findings of the current study, serum ferritin level can be used a predictive marker for the development of GDM.

A Hospital-based Study to Assess Various Laboratory Parameters for Prediction of Severity of COVID-19 Disease at the Time of Admission at a Teaching Tertiary Hospital

Abstract Background: The main aim of this study was to determine the association between various laboratory parameter values at the time of admission with the severity classification of COVID-19 infection. Secondarily, this study also determined the cutoff value of associated laboratory parameters with the severity of infection at the time of admission. This study evaluated the association of laboratory parameters and other factors with the severity of COVID-19 infection (mild, moderate, and severe). Methodology: This study analyzed 170 adult patients with symptomatic COVID-19 infection hospitalized between July 2020 and December 2020 at a teaching tertiary care center in South Gujarat. All the patients selected in the study had a positive polymerase chain reaction test result of SARS-CoV-2. Laboratory parameters and clinical details of patients were recorded. Results: A total of 170 COVID-19-infected hospitalized patients were analyzed. The serum ferritin levels were 1.12 times higher in severe patients compared to mild category patients and 1.006 times higher in severe patients compared to moderate category patients, as determined using multinomial logistic regression. The requirement of invasive positive pressure ventilation (IPPV), BIPAP, and nonrebreathing mask at admission was substantially linked with patients in the severe and moderate categories (P &lt; 0.0001). Compared to the mild category, the need for IPPV was 534.9 (95% confidence interval [CI]: [21.93–13022.20]) times greater in the severe category, and 50.41 (95% CI: [3.034–837.55]) times higher in the severe individuals. In addition, this study also evaluated the cutoff value for serum ferritin was identified at ≤276.35 ng/mL for mild, 276.35–473.5 ng/mL for moderate, and ≥473.5 as severe COVID-19 infection at the time of admission. Conclusion: Early ferritin estimation could be used to assess the severity and categorization of COVID-19 infection at the time of admission itself and can be of immense benefit in the treatment of the disease.

Meta-analysis of the prognostic value of pretreatment serum ferritin in hepatobiliary and pancreas (HBP) cancers

Background and objectivesStudies have shown that serum ferritin (SF) has unfavourable prognostic value in hepatobiliary and pancreas (HBP) cancers. This meta-analysis aimed to comprehensively assess the prognostic role of pretreatment...

Serum Ferritin as a Diagnostic Biomarker for Kawasaki Disease.

Diagnosis of Kawasaki disease (KD) is occasionally delayed because it is solely based on clinical symptoms. Previous studies have attempted to identify diagnostic biomarkers for KD. Recently, patients with KD were reported to have elevated serum ferritin levels. We investigated the usefulness of the serum ferritin level as a diagnostic biomarker for distinguishing KD from other acute febrile illnesses. Blood samples were obtained from pediatric patients with KD (N=77) and those with other acute febrile illnesses (N=32) between December 2007 and June 2011 for measuring various laboratory parameters, including serum ferritin levels. In patients with KD, laboratory tests were performed at diagnosis and repeated at 2, 14, and 56 days after intravenous immunoglobulin treatment. At the time of diagnosis, serum ferritin levels in patients with KD (188.8 μg/L) were significantly higher than those in patients with other acute febrile illnesses (106.8 μg/L, P=0.003). The serum ferritin cut-off value of 120.8 μg/L effectively distinguished patients with KD from those with other acute febrile illnesses, with a sensitivity and specificity of 74.5% and 83.3%, respectively. Serum ferritin may be a useful biomarker to distinguish KD from other acute febrile illnesses.

Correlation analysis between serum ferritin level and liver damage in acute stage of dengue fever

Objective: To investigate the correlation between serum ferritin (SF) level and liver damage in the acute stage of dengue fever. Methods: A retrospective study was conducted to analyze 171 cases diagnosed with dengue fever as dengue fever group and 130 healthy patients as control group in Hangzhou 3A grade hospital from July to December 2017. Clinical data, SF and liver function related indicators were collected from both groups: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) to analyze the correlation between liver damage and SF in patients with dengue fever. Results: ALT, AST, and SF levels were significantly higher in the dengue fever group than those in the healthy control group (Z = 11.553, 15.054 and 15.163, P < 0.001). SF levels were higher in the dengue fever combined with liver damage group than those without the liver damage group (z = 6.930, P < 0.001). However, there was no statistically significant differences in age, gender, peak body temperature, and history of liver disease (P > 0.05). In addition, Spearman's correlation analysis showed that SF was positively correlated with ALT, AST, and TBIL (r = 0.464, 0.531 and 0.315, P < 0.001). Among dengue patients with different SF levels, there were significant difference in ALT, AST levels and incidence of liver damage (H = 14.240 and 17.584, χ(2) = 49.547, P < 0.001). Patients with higher SF levels had higher ALT, AST levels and incidence of liver damage. Binary logistic regression analysis showed that hyperferritinemia (SF≥500 ng/ml) was the risk factor for dengue fever combined with liver damage (OR = 8.120, P < 0.001). Furthermore, ROC curve analysis showed that the AUC for SF to judge dengue fever combined liver damage was 0.846 (95% CI: 0.785-0.908), and the sensitivity and specificity when the SF cut-off value was 1 506 ng/ml were 74.8% and 83.3%. Conclusion: There is a certain correlation between the SF level and the degree of liver damage in acute stage of dengue fever patients, and hyperferritinemia is a risk factor for dengue fever combined with liver damage.

Evaluation of Iron Status in Children with Autism Spectral Disorder: A Case-control Study

Introduction: Iron is an important factor in neural development. Iron Deficiency (ID) and Iron Deficiency Anaemia (IDA) anaemia is highly prevalent in patients of autism. There are a very small number of studies to show association between iron profile and autism. Aim: To investigate factors affecting iron status such as hemoglobin (%), serum iron, ferritin, and Total Iron Binding Capacity (TIBC) level in children with Autism Spectral Disorder (ASD) and healthy control. Materials and Methods: It was a case-control study done from April 2018 to April 2019. Total 100 participants were recruited of which 50 autistic patients were taken as cases, and 50 healthy subjects were taken as control. Childhood Autism Rating Scale (CARS) was used to evaluate the severity of autistic symptoms. Cut-off value of serum ferritin was &lt;10 ng/mL for preschoolers (&lt;6 years) and &lt;12 ng/mL for school-aged (&gt;6 years) children to evaluate ID. Anaemia was defined as haemoglobin &lt;11.0 g/dL for preschoolers and &lt;12.0 g/dL for school-aged categorical variables and were compared by using chi-square test. Normally distributed parametric variables were compared between groups by using independent samples t-test. Serum ferritin, iron, TIBC values were compared between severe, mild-moderate and control groups with ANOVA. The p-value &lt;0.05 was accepted to be statistically significant. Results: Mean serum levels of ferritin iron TIBC were significantly reduced in ASD patients (p&lt;0.001). The level of haemoglobin was also lower in ASD patients but it was not significant. Risk of ID and IDA was higher than normal subjects (RR for ID 1.74). Level of serum ferritin, iron and TIBC was lowest in severe autism as compared to mild-moderate autism and control groups. Conclusion: These findings suggest iron and ferritin levels should be measured in autistic patients as a baseline investigation and it may be used as a screening test for ASD.

Attempt to Determine the Cut-Off Value of Serum Ferritin for Iron Deficiency in Male College Student Runners.

For the evaluation of iron nutrition status, the measurement of serum ferritin levels is the most convenient and widely used technique for estimating stored iron. However, the cut-off value of serum ferritin for iron deficiency in athletes has not yet established. This study aimed to determine the cut-off value of serum ferritin to define iron deficiency in male college student runners. This study included 37-43 Japanese male college student runners for each month. Anthropometric measurements and blood collection were conducted from March to December 2018. In all months except May, significant negative correlations were observed between serum ferritin and transferrin levels, total iron binding capacity (TIBC), and unsaturated iron binding capacity. Furthermore, a significant association between serum ferritin levels and TIBC was observed by nonlinear regression analysis. The curvature radius and curvature were calculated using the data from 9 mo, and serum ferritin levels with the smallest curvature radius and the highest curvature in each month were identified. The serum ferritin levels were as follows: 35.0 ng/mL in March, 45.0 ng/mL in April, 40.0 ng/mL in June, 35.0 ng/mL in July, 35.0 ng/mL in August, 35.0 ng/mL in September, 35.0 ng/mL in October, 35.0 ng/mL in November, and 40.0 ng/mL in December. The average value was 37.2 ng/mL. In conclusion, the cut-off value of serum ferritin for defining iron deficiency in runners was determined to be 40.0 ng/mL in this study. This value (40.0 ng/mL) may be useful for iron deficiency screening in runners.

The impact of iron chelation therapy on patients with lower/intermediate IPSS MDS and the prognostic role of elevated serum ferritin in patients with MDS and AML: A meta-analysis.

Serum ferritin (SF) has been identified as a potential prognostic factor for patients undergoing stem cell transplantation, but the prognostic value of SF in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) patients and the impact of iron chelation therapy (ICT) on MDS patients are controversial. The present meta-analysis aimed to better elucidate these relationships.Three electronic databases were searched systematically to identify reports on the prognostic role of SF in MDS and AML patients, and those investigating the impact of ICT on prognosis of MDS patients. The hazard ratios (HRs) and its 95% confidence interval (95%CI) were extracted from the identified studies using Cox proportional hazard regression model for overall survival (OS) and progression of MDS to AML.Twenty reports including 1066 AML patients and 4054 MDS patients were included in present study. The overall pooled HRs for OS of AML and MDS patients with elevated SF prior to transplantation was 1.73 (1.40-2.14), subgroup analyses stratified by the cut-off value of SF ≥1400/1000 ng/mL showed that the pooled HRs were 1.45 (0.98-2.15) and 1.65 (1.30-2.10), respectively. The pooled HRs for ICT in MDS patients was 0.30 (0.23-0.40). For ICT, the pooled HRs for the progression of MDS to AML was 0.84 (0.61-1.61).SF has a negative impact on the OS of AML and MDS patients when it is higher than 1000 ng/mL. ICT can improve the OS of MDS patients with iron overload but it is not associated with the progression of MDS to AML.

Serum ferritin as an indicator of body iron stores in anemic patients

Serum ferritin concentrations have been documented to give an accurate indication of the amount of storage iron not only in healthy individuals but also in cases of iron deficiency or iron over load. A low serum ferritin is highly indicative of deficient iron stores. Values less than 15ng/ml are indicative of negative iron balance or decreased stores. In cases of anemia of chronic diseases, serum ferritin levels are increased as serum ferritin is an acute phase reactant. Thus, in patients of anemia of chronic diseases with concomitant iron deficiency, serum ferritin may not be below 15ng/ml and serum ferritin may not give a true picture of deficiency in these patients. In the present study, we determined the role of serum ferritin as an indicator of body iron stores along with the cut-off value for serum ferritin to detect hypoferremia in patients of anemia of chronic diseases.

Serum ferritin as a diagnostic marker for cardiac iron overload among beta-thalassemia major children

Introduction: Beta-thalassemia major is the most common chronic hemolytic anemia. It is a well-comprehended fact that the toxic effects of iron overload particularly the cardiomyopathy are the major complication that roots from beta-thalassemia major children. Therefore, timely diagnosis is crucial to optimize the long-term gain. Objective: The objective of the study is to find the cutoff level of serum ferritin for early diagnosis of cardiac iron overload. Materials and Methods: This study was an observational analytical cross-sectional diagnostic study which was conducted from November 2016 to October 2018. With due approval of Institutional Ethics Committee and after taking proper informed consent from the parents and/or legal heir, 105 thalassemic children were enrolled in the study by simple consecutive sampling after satisfying the pre-defined inclusion and exclusion criteria. In this study, two-dimensional Doppler echocardiography was used to detect cardiac iron overload. Serum ferritin levels were estimated, and cutoff values were calculated for each of the echocardiographic parameters of cardiac iron overload, i.e. ejection fraction (EF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD) by receiver operating characteristic curve analysis. Sensitivity (Sn), specificity (Sp), positive predictive value, and negative predictive value were calculated with considering p&lt;0.05 as statistically significant. Results: The mean age of the study participants was 9±3 years. Cutoff value of serum ferritin for detecting abnormality in EF was 3286 ng/ml with Sn of 76.1% and Sp of 88.1%. Similarly, for detecting abnormal LVEDD, cutoff value of serum ferritin was 4640 ng/ml with Sn of 70.1% and Sp of 98.6%, and for LVESD, it was 3286 ng/ml with Sn of 90% and Sp of 70.5%. Conclusion: The serum ferritin level can be used as a reliable marker of myocardial iron overload among childhood beta-thalassemia and hence can be used as an important screening tool.

Relationship between serum ferritin level and the severity of community acquired pneumonia in children

Objective To analyze the relationship between the level of serum ferritin (SF)and the severity of community acquired pneumonia (CAP)in children, and to explore the timing of glucocorticoid therapy for children with CAP. Methods Retrospective analysis was performed on the clinical data of 738 children with CAP who were hospita-lized at the Department of Respiratory, Beijing Children′s Hospital, Capital Medical University from January 2014 to December 2015.All patients were divided into a mild group and a severe group based on the severity of CAP, and the levels of SF, C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), white blood cell(WBC) and D-dimer were compared between the 2 groups.In addition, the analysis of receiver operating characteristic(ROC) curve was performed to study the usefulness of SF as severity indicators for CAP, and to learn the relationship between the level of SF and the glucocorticoid therapy in children with CAP.Simultaneous analysis of SF and CRP, WBC, ESR, D-dimer was made at the same time. Results (1) There were all 738 children enrolled into this study.There were 442 children in the mild group and 296 children in the severe group.There was no significant difference in age and sex between the mild group and the severe group(all P>0.05). (2)Comparisons between the mild group and the severe group were as follows: days of hospitalization [10.0(9.0, 13.0) days], duration of fever [10.0(7.0, 10.0)days] and heat peak[39.9 ℃(39.1 ℃, 40.1 ℃)]in the severe group, which had significant differences than those in the mild group [days of hospitalization 7.0(6.0, 9.0) days, duration of fever 7.0(5.0, 10.0) days and heat peak 39.3 ℃(39.0 ℃, 39.8 ℃)](all P<0.05). The levels of SF[ 229.0(150.0, 436.2) μg/L], CRP [30.00(9.84, 78.20) mg/L], WBC [8.44(5.91, 12.6)×109/L], ESR [30.5(16.0, 49.0) mm/1 h ]and D-dimer [0.871(0.317, 2.532) μg/L] in the severe group were significantly higher than those in the mild group [SF: 98.0(68.2, 136.1) μg/L, CRP: 11.50(5.77, 11.50) mg/L, WBC: 7.59(5.87, 10.1)×109/L, ESR: 23.0(13.0, 36.3) mm/1 h and D-dimer 0.232(0.159, 0.407) μg/L], and the differences were statistically significant (all P<0.05). (3)The le-vels of SF [258.5(177.8, 404.9) μg/L] and CRP [8.0(8.0, 16.5) mg/L]in CAP children in the recovery phase were significantly lower than those in the acute phase [SF: 912.1(418.7, 1 380.3) μg/L, CRP: 47.4(18.8, 105.8) mg/L]. (4)The level of SF had significantly positive correlations with CRP, ESR, D-dimer (r=0.485, 0.286, 0.611, all P<0.05). (5) The cutoff value for SF, D-dimer for diagnosing severe pneumonia was 168.0 μg/L (sensitivity 70.6%, specificity 86.2%), and 0.616 μg/L (sensitivity 58.1%, specificity 87.1%). (6) There were 17.2% cases (76/442 cases) in the mild group and 52.7% cases (159/296 cases) in the severe group who received systemic glucocorticoid therapy. Conclusion The level of SF was correlated with the severity of CAP in children, and the level of SF in patients in recovery phase was significantly lower than that in the acute phase.When SF ≥168.0 μg/L, D-dimer ≥0.616 μg/L, attention should be paid to the possibility of severe CAP, regarding the indication for systemic steroid therapy for CAP in children. Key words: Serum ferritin; Community acquired pneumonia; Glucocorticoid; Child

Ability of serum ferritin to diagnose iron deficiency anemia in an elderly cohort.

BackgroundDiagnosis and treatment of iron deficiency anemia in older subjects improves their quality of life. Serum ferritin as a marker of iron stores is an acute phase protein. In older subjects who usually have many concomitant chronic medical conditions, serum ferritin may increase in response to inflammatory processes irrespective of iron stores. This study was performed to determine the diagnostic properties of serum ferritin in the diagnosis of iron deficiency anemia in older subjects.MethodsThis case–control study included all the inhabitants of Amirkola town who participated in the Amirkola Health and Aging Project. Diagnosis of anemia was confirmed based on a hemoglobin level <13 g/dL in men and <12 g/dL in women and iron deficiency anemia by percent transferrin saturation <15%. A receiver operating characteristic curve was constructed to determine an optimal serum ferritin cutoff value to differentiate patients with and without iron deficiency anemia at the highest sensitivity and specificity.ResultsEighty patients with iron deficiency anemia and 160 cases of anemia without iron deficiency (mean age: 72.9 ± 8 and 71.6 ± 7.6 years, respectively; p-value = 0.37) were analyzed. In iron deficiency anemia, the mean serum ferritin was significantly lower (p-value = 0.036) compared to patients without iron deficiency anemia. Serum ferritin with a cutoff level of 100 ng/mL differentiated patients with and without iron deficiency anemia with a sensitivity of 60% and specificity of 59% and area under the receiver operating characteristic curve of 0.615 ± 0.040 (95% confidence interval: 0.536–0.694; p-value = 0.004).ConclusionThese findings indicate that in elderly subjects, iron deficiency anemia may develop with higher levels of serum ferritin. Hence, the conventional cutoff of serum ferritin for the diagnosis of iron deficiency anemia in young adults is not appropriate for the elderly population.

Hyperferritinemia as a Diagnostic Marker for Severe Fever with Thrombocytopenia Syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral disease in East Asia with high mortality. Few studies have examined markers that suggest SFTS in febrile patients. To determine useful biochemical markers for SFTS, patients aged 18 years or older with SFTS or microbiologically confirmed community-onset bacteremia with thrombocytopenia (BT) at presentation between June 2013 and December 2015 were included from two tertiary university hospitals in Republic of Korea retrospectively. Eleven patients with SFTS and 62 patients with bacteremia and thrombocytopenia were identified in the study period. Age and sex did not show significant difference among two groups. Fever was more commonly observed but comorbidities were less common in SFTS than in BT (P < 0.05, each). The areas under the curves of serum ferritin, C-reactive protein, white blood cell count, serum procalcitonin, and fibrinogen were above 0.9, indicating the discriminative power of these biomarkers (1.000, 0.991, 0.963, 0.931, and 0.934, resp., all P < 0.05). The optimal cutoff value of serum ferritin was 3,822 ng/mL in this study. These results suggest that hyperferritinemia is a typical laboratory feature of SFTS, and the serum ferritin level can be used as a marker for clinicians suspecting SFTS.

Study of anemia in nondialysis dependent chronic kidney disease with special reference to serum hepcidin.

We studied the role of serum hepcidin in anemia of chronic kidney disease (CKD) in a hospital-based cross-sectional study. Serum hepcidin, ferritin, and high-sensitivity C-reactive protein (hsCRP) levels were evaluated in patients of CKD. Hepcidin levels were increased in patients as compared to healthy adults. Hepcidin levels increased as CKD progressed through stage 3–5 (P trend = 0.015) but did not correlate with estimated glomerular filtration rate. Hepcidin correlated positively with ferritin (P < 0.0001) and transferrin saturation (TSAT) (P = 0.0217) and negatively with erythropoietin (EPO) levels (P = 0.0258) but did not correlate with either hsCRP or estimated glomerular filtration rate. Iron status influenced hepcidin levels of patients. Patients were divided according to iron status on the basis of TSAT and serum ferritin levels. We observed that while absolute iron deficiency (transferrin saturation <20%, ferritin <40 ng/ml) is associated with downregulation of hepcidin, hepcidin is elevated in other two categories of CKD patients (P = 0.0039). Iron status of patients also influenced interaction between hepcidin and hemoglobin (Hb). Hepcidin correlated negatively with Hb in patients with sufficient iron status (r = −0.7452, P < 0.0001) but nearly correlated positively with Hb in patients with absolute iron deficiency (r = 0.9428, P = 0.0572). Almost similar association persisted when cutoff value for serum ferritin was raised to 100 ng/ml as per NKF/KDOQI 2006 clinical practice guidelines except that no association was observed in absolute iron deficiency category. Cutoff value for hepcidin for differentiating absolute iron deficiency from other categories in our study population is ≤ 34 ng/ml (area under curve = 0.836, P < 0.0001). In conclusion, serum hepcidin level is increased in nondialysis CKD patients as compared to healthy adults possibly due to associated inflammation and decreased renal clearance. Furthermore, iron status modifies hepcidin level and its association with Hb. Raised hepcidin can predict the need for parenteral iron therapy and need for higher dose of recombinant human EPO to overcome iron-restricted erythropoiesis.

The Prevalence of Zinc Deficiency and its Correlation with Iron Status and Economical Living Area in 9 - 12-Year-Old Children.

This study aimed firstly to assess zinc and iron status of 9-12-year-old children of Tehran and secondly to determine a cut-off for circulating biomarkers of iron status to identify children at increased risk of zinc deficiency. In a cross-sectional study, demographic and anthropometric data from 505 boys and 467 girls aged 9-12 years from Tehran primary schools were obtained and their zinc and iron status was assessed. The prevalence of zinc deficiency, anemia, and iron depletion was 12.4, 14.6, and 9.5%, respectively. Serum zinc con-centration was significantly lower in children with anemia than in their non-anemic peers (p < 0.05). There was no significant association between zinc and iron status and serum high sensitivity C-reactive protein. Zinc-deficient children, compared to those with normal serum zinc, had significantly shorter stature (139.7 (±6.9) vs 141.3 (±7.1) cm, CI: -2.97 - -0.2, p = 0.029). Serum zinc concentration was the predictor of height in the children (p = 0.004, CI: 0.01 - 0.054). A logistic regression model showed an increased risk of low serum zinc and ferritin in children who resided in economically poor regions (OR = 1.65, p = 0.043; OR = 1.92, p = 0.016, respectively). Using ROC curve and Youden index, the optimal cut-off value for serum ferritin to indicate zinc deficiency was 14.9 µg/L (sensitivity = 90%, specificity = 61%). Lowered zinc and iron status among the children in deprived regions is likely to be due to poor quality of diet. Moreover, children with serum ferritin lower than 14.9 µg/L must be carefully assessed for concomitant zinc deficiency.

Serum ferritin level in type 2 diabetes mellitus -A case control study

Background: Hyperferritinemia probably contributes insulin resistance and subsequently to decreased insulin secretion causes for development of insulin resistance. Objectives: Compare HbA1c with Ferritin and find correlation between HbA1c and ferritin in type 2 diabetes mellitus patients, and also to find the best cut-off value for serum ferritin. Material and methods: The study was conducted on type 2 diabetes mellitus patients attended the outpatient department. Totally 99 participants were enrolled for the study, out of which 49 were cases and 50 were age and sex controls. The FBS, PPBS, HbA1c and serum ferritin were estimated. Statistical package for social science software version 19.0 was used for statistical analysis. Results: There statistically significant increase in all the biochemical parameters viz FBS, PPBS, HbA1c and serum ferritin levels in cases compared controls. The p value was 0.0001 for all the parameters, which is highly significant. There was a positive correlation between the HbA1c and Ferritin levels, but it was not statistically significant (r = 0.10). The area under the ROC curve for serum ferritin values at various cut-off was 0.904 and the best cut-off of serum ferritin levels greater than 124ng/ml. Conclusion: Serum ferritin levels were higher in type 2 Diabetes mellitus which positively correlated HbA1c. Thus, routine screening for serum ferritin concentration in diabetes patients can be done to assess the glecemic control in type 2 DM. Key words: Type 2 Diabetes Mellitus, Serum ferritin

Serum Ferritin Levels Are Positively Associated With Metabolically Obese Normal Weight

The purpose of this study was to examine the relationship between serum ferritin levels and metabolically obese normal weight (MONW) and to determine the appropriate cut-off value of serum ferritin for the prediction of clinical metabolic status in nonobese Korean adults. Data from 9411 participants in the fourth (2008) and fifth (2010) annual Korea National Health and Nutrition Examination Surveys were used in this study. MONW was determined by combining National Cholesterol Education Program Adult Treatment Panel III criteria, Wildman criteria, and homeostatic model assessment criteria for metabolic healthy obesity. The mean serum ferritin level was 103.5 ± 1.2 ng/mL in men and 45.5 ± 0.6 ng/mL in women. The estimated cutoff value of serum ferritin for the prediction of MONW was 127.03 ng/mL in men and 46.87 ng/mL in women. Both men and women who had higher serum ferritin levels than the cutoff value had a higher prevalence of MONW than those individuals who had lower serum ferritin levels than the cutoff value. In the final multivariable adjusted logistic regression model, the odds ratio (95% confidence interval) of MONW in the subjects who had higher serum ferritin levels than the cutoff value was 1.631 (1.312-2.028) in men and 1.298 (1-1.685) in women. In this study, serum ferritin levels were positively associated with MONW, and those subjects who had higher serum ferritin levels than the cutoff value had a higher prevalence and a higher adjusted odds ratio for MONW despite being nonobese.