Ferritin Index Research Articles

P176 The effect of induction therapy with infliximab or vedolizumab on hepcidin and iron status in patients with Inflammatory Bowel Disease

Abstract Background Differentiating absolute iron deficiency from functional iron restriction is challenging in active Inflammatory Bowel Disease (IBD). Hepcidin, the systemic iron regulator, could be the key in the diagnosis and management of absolute iron deficiency. In this study, we assessed hepcidin as a diagnostic iron deficiency marker and we explored the relationship between hepcidin, inflammation, hypoxia, and iron deficiency in patients receiving induction therapy with infliximab (IFX) or vedolizumab (VEDO). Methods 130 patients with IBD, who received induction therapy with IFX or VEDO for active disease, were included in this study. Clinical and biochemical data were extracted from medical records. Serum samples at baseline and week 6 of induction therapy were retrieved from the University Medical Center Groningen (UMCG) biobank and analysed for: hepcidin, inflammation (e.g., interleukins [IL] 6, 10, and Tumour Necrosis Factor-α [TNFα]), oxidative stress (free thiols), and hypoxia (e.g., erythropoietin [EPO], Macrophage Inflammatory Protein-3α [MIP3α]). For comparison, serum samples from 50 age- and gender-matched healthy controls were obtained from pre-donation biobank at the UMCG. Response to therapy was defined by either General Physician’s Assessment at week 14 of induction therapy, normalisation or at least a three-point decrease in clinical scores: Harvey-Bradshaw Index (HBI) for Crohn’s Disease, Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis. Results Hepcidin correlated with ferritin and sTfR/log ferritin index [ρ = 0.74 and ρ = -0.79, respectively; P<0.001 for both markers], while inflammation- and hypoxia-associated markers showed only marginal correlations. Hepcidin accurately identified absolute iron deficiency: AUC(hepcidin) = 0.89 [95% CI: 0.82–0.95; P<0.001]. Induction with either IFX or VEDO decreased hepcidin [13.5 ng/mL vs. 9.5 ng/mL; P<0.001], ferritin [45.5 ug/L vs. 37.0 ug/L, P<0.05], and inflammatory markers at week 6, while transferrin increased [2.4 g/L vs. 2.5 g/L, P<0.001]. In total, 75.4% of patients responded to the induction therapy. Hepcidin and ferritin decreased, while transferrin increased (P<0.001 for all changes) in patients who responded to the therapy. In addition, hypoxia (EPO and MIP3α) and inflammatory markers such as faecal calprotectin, IL-6, IL-22, and TNFα improved significantly. In contrast, none of these improvements were observed in patients who did not respond to the therapy. Conclusion Hepcidin reflects iron deficiency in active IBD, but inflammation masks the severity of the deficiency. Induction therapy with either IFX or VEDO modulates hepcidin and iron indices, especially in patients who respond to the therapy.

Ferric carboxymaltose for treatment of iron deficiency and iron deficiency anemia caused by abnormal uterine bleeding.

Heavy menstrual bleeding leads to depletion of iron stores, with subsequent iron deficiency (ID) and iron deficiency anemia (IDA). To evaluate the efficacy and safety of ferric carboxymaltose (FCM) in treatment of ID/IDA caused by abnormal uterine bleeding (AUB). One hundred and twenty women ≥ 40 years old with chronic AUB and ID/IDA were included in this study for correction of ID/IDA. Participants received FCM infusion for correction of ID/IDA. The pre-treatment ferritin, hemoglobin (Hb), red blood cell (RBC) mean corpuscular volume (MCV), and RBC mean corpuscular hemoglobin (MCH) values were compared with the 6- and 12-week post-treatment values. The pre-treatment ferritin and Hb levels significantly increased from 13.2 ±7.4 µg/l and 8.8 ±0.8 g/dl, respectively, to 111.5 ±5.6 µg/l and 13.9 ±0.6 g/dl, respectively, 6 weeks after FCM (p = 0.001 and 0.0009; respectively), and to 98.7 ±6.1 µg/l and 12.9 ±0.65 g/dl, respectively, 12 weeks after FCM (p = 0.01 and 0.01; respectively). In addition, the pre-treatment RBC MCV and RBC MCH values significantly increased from 74.3 ±2.3 fl and 26.6 ±5.3 pg, respectively, to 88.7 ±1.9 fl and 29.6 ±4.5 pg, respectively, 6 weeks after FCM (p = 0.01 and 0.03, respectively), and to 93.3 ±1.75 fl and 30.3 ±3.8 pg, respectively, 12 weeks after FCM (p = 0.001 and 0.0001, respectively). FCM was safe and effective for correction of ID/IDA caused by chronic AUB within 6 weeks. The serum ferritin, Hb, and RBC indices remained significantly high compared to the pre-treatment values 12 weeks after FCM infusion.

Determining sleep quality and investigating its relationship with various demographic and biochemical factors in hemodialysis patients

Introduction: Sleep disorders are one of the most common disorders among hemodialysis patients which is associated with the demographic and laboratory factors of such patients. Objectives: The present study aims to investigate the quality of sleep and its relationship with some demographic and biochemical factors in a group of hemodialysis patients. Patients and Methods: This study is cross-sectional conducted on end-stage renal disease (ESRD) patients who underwent regular and continuous hemodialysis in Amin hospital of Isfahan. The Pittsburgh Sleep Quality Index (PSQI) was completed face-to-face for each individual. Other data included age, hemoglobin and hematocrit, adequacy of hemodialysis, serum alkaline phosphatase, ferritin, iron, calcium, phosphorus, parathyroid hormone and body mass index were receded too. Results: In this study, 110 hemodialysis patients were investigated (71 men). In this study, 41.8% of the patients had sleep disorder. We found, no difference between demographic and laboratory factors of patients with and without sleep disorder (P>0.05 for all parameters). No significant difference was detected among men and women regarding sleep disorder (P>0.05). Accordingly, no significant difference in sleep disorder between patients with and without diabetes was found too (P>0.05). However, our study showed a significant direct relationship between age and sleep disorder (P=0.026) particularly in women (P=0.011). Conclusion: Sleep disorder is common in patients undergoing hemodialysis and is directly related to the patients’ age; however, larger studies in this field are necessary.

Iron Status of the Moderate and Late Preterm Infant: A Prospective Cohort Study

Guidelines on micronutrient supplementation in moderate to late preterm infants (MLP) are mostly extrapolated from those for smaller preterms, largely due to lack of systematic studies on physiological status in this special group of infants. Actual practices vary widely. We prospectively studied iron status by measurement of serum ferritin (SF) and haematological indices at 4 months corrected age in infants born between 32 and 36 weeks gestation (MLP), after they received 2 mg/kg/day oral iron from 6 weeks of postnatal age. Proportion of MLP having normal iron status (iron replete), i.e., neither iron deficiency (ID) nor iron excess was measured. ID anaemia, growth and development, risk factors for ID were also analysed. Of the 82 infants studied, 78% babies were late preterm. Seventy-four (90.3%) were iron replete (no deficiency or excess) at 4 months. High variability in SF levels (minimum of 9.8 to maximum of 252.2 μg/l) with median (IQR) of 57.45 μg/l (37.02-98.85) was noted in the entire cohort; and also within those who were iron deficient with median (IQR) of 17.50 μg/l (11.70-18.90). There was no difference in haematological indices of ID infants when compared to those with normal iron status. Inspite of oral iron supplementation with reasonable compliance, 8.5% MLP were iron deficient at 4 months corrected age. The high variability noted in SF levels could justify the need for monitoring iron status in this group of preterm infants. This could quintessentially aid individualization of iron supplementation advice.

Role of ferritin and oxidative stress index in gestational diabetes mellitus.

To investigate the role of serum ferritin and oxidative stress in the development of GDM and to assess their relationship with the ensuing hyperglycemia. A case-control study was carried on 90 non-anemic pregnant women of 20-40years with a gestation of 24-28weeks. Study group (n = 65) was identified according to the Diabetes in Pregnancy Study Group India (DIPSI) criteria (2-h plasma glucose ≥ 140mg/dl) and controls (n = 25) having 2-h plasma glucose < 120mg/dl. DIPSI 2-h plasma glucose, HbA1c and serum ferritin were measured and oxidative stress index (OSI) was calculated. Statistical tests were performed using SPSS version 25.0. Pre-pregnancy BMI showed a significant difference between control and study group. DIPSI 2h blood glucose, HbA1c, serum ferritin and OSI were significantly higher in study group compared to control group. Both 2h blood glucose and HbA1c were positively correlated with serum ferritin and OSI, serum ferritin and OSI were also positively correlated with each other. Higher pre-pregnancy BMI elevates serum ferritin, which in turn increases the OSI. Both ferritin and oxidative stress raises 2h blood glucose and HbA1c in GDM patients possibly by causing in-vivo pancreatic β -cell injury and death (ferroptosis). Serum ferritin and OSI could become newer personalized theranostic and monitoring targets in overweight/obese pregnant females especially GDM patients.

Показники трансферину та феритину в дітей із надлишковою масою тіла й ожирінням

Актуальність. Ожиріння розглядається як хронічне системне запалення низької активності. Триває накопичення відомостей про біологічне і клінічне значення металопротеїнів у запальному процесі. Мета: дослідити показники феритину (ФН) та трансферину (ТФ) у крові дітей із надлишковою масою тіла й ожирінням. Матеріали та методи. Обстеження дітей із надлишковою масою тіла (НдМТ, 60 осіб), ожирінням (Ож, 45 осіб), нормальною масою тіла (НмМТ, 60 осіб), дефіцитом маси тіла (ДМТ, 30 осіб) віком 13–18 років включало збір анамнезу, антропометрію (зріст, маса тіла, індекс маси тіла, співвідношення окружність талії/окружність стегон), вміст глюкози, інсуліну, розрахунок HOMA-IR, вміст трансферину і феритину. Для статистичної обробки результатів використано статистичні модулі програми Statistica v.6.0 та MedStat та on-line калькулятор SISA. Результати. У загальній вибірці із 325 осіб НдМТ встановлено у 75 (23,1 %) дітей, Ож — у 45 (13,8 %), ДМТ — у 30 (9,2 %), у решти 175 (53,8 %) — НмМТ. Серед осіб із НдМТ переважали хлопчики, кількість яких становила 40 (53,3 %) і серед осіб із Ож — 25 (55,5 %). Вищий вміст ТФ відзначено в дітей віком 16–18 років (3,9 ± 0,7 г/л, n = 100; p &lt; 0,05). Найвищий вміст ТФ зареєстровано в дітей із Ож II ступеня — 3,98 ± 0,90 г/л (n = 16) проти 3,05 ± 0,61 г/л (n = 29) (p &lt; 0,05) у дітей із Ож I ступеня. Аналогічна тенденція встановлена і щодо показників ФН у плазмі крові обстежених дітей. Так, вірогідно вищі показники ФН встановлено в дітей із Ож II ступеня — 178,9 ± 22,8 нг/мл (n = 16) проти 125,8 ± 0,7 нг/мл (n = 29) (p &lt; 0,05) у дітей із Ож I ступеня та у дітей віком 16–18 років — 176,2 ± 12,8 нг/мл (n = 25) проти 149,9 ± 11,3 нг/мл (n = 20) (p &lt; 0,01) у дітей 13–15 років. Вірогідної різниці в гендерних показниках ТФ та ФН не встановлено. Висновки. Оцінка маркерів системного запалення як метод раннього виявлення ожиріння є актуальним і перспективним напрямком з оптимізації системи профілактики ожиріння.

Cytokine storm in severe patient COVID-19 and curative plasmapheresis

Background: In the intensive care unit, the curative plasmapheresis technique is widely applied among severe patients, who show signs of both endogenous and exogenous intoxication. The impact of isovolemic isooncotic curative plasmapheresis on the status of hemoleukogram and immunological markers has not been studied yet. Material and methods: The study is retrospective, observational. The medical records of 34 COVID-19 patients from the COVID intensive care units of Timofei Mosneaga Republican Clinical Hospital who benefited from isovolemic, curative isooncotic plasmapheresis were analyzed. There were 25 complete, analyzed data sets. General data were recorded: preplasmapheresis, postplasmaphesis hemoleukogram. Results: Isovolemic, isooncotic plasmapheresis, performed in patients with severe COVID-19, SARS-CoV2 showed effects of improving the status of laboratory indices that denote the evolution and favorable prognosis of the disease. The activity of the cytokine storm decreased in both groups of patients, both in those with a mean age of up to 60 years and in those over 60 years of age, with p = 0.001. Patients over 60 years of age had a marked improvement in serum ferritin index, compared to patients in the age group up to 60 years, in the period after plasmapheresis, p = 0.043. Analogously, the level of C-reactive protein was analyzed, which clearly decreases in patients &lt;60 years of age, compared to those&gt; 60 years of age, p = 0.037 Conclusions: Isovolemic, isooncotic plasmapheresis is a procedure performed in severe COVID-19 (SARS-CoV-2) patients to improve the status of the cytokine storm. Moreover, the performance of the procedure in different age groups induced an improvement in the satiety of hemoleukogram and proinflammatory indices.

MO557EFFICIENCY OF FERRIC CARBOXYMALTOSE IN NON-DIALYSIS CKD PATIENTS AND ITS IMPACT ON KIDNEY FUNCTION: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract Background and Aims Iron deficiency anemia occurs in the vast majority of patients with chronic kidney disease (CKD). The aim of this study was to investigate the efficacy of ferric carboxymaltose (FCM) iron deficiency anemia’s treatment in non-dialysis CKD patients and to clarify its impact on kidney function. Method Prospective observational study of non-dialysis CKD stage 3 to 5 patients, with anemia and iron deficiency treated with FCM from 01 January 2019 to 31 June 2020. FCM was administrated as a single IV infusion of 500mg or 1000mg. Baseline clinical, analytical and demographic data were recorded. FCM efficacy was evaluated by comparing hemoglobin (Hb), serum ferritin and transferrin saturation index (TSAT) 24 ± 8 weeks after the infusion with analytical values at baseline. Renal function was also assessed at baseline and at 24 ± 8 weeks using estimated glomerular filtration rate (eGFR), calculated by CKD-EPI formula. Statistical analysis was executed using SPSS (Version 23 for Mac OSX). Results The average age of 71 patients was 77.31 ± 9.68 years, 29 (40.8%) were male, 46 (64.8%) were diabetic and 41 (57.8%) had congestive heart failure. Sixteen (22.5%) patients had CKD stage 3, 41 (57.7%) stage 4 and 14 (19.7%) stage 5. Twenty-five (35.2%) patients were treated with 1000mg of FCM. At baseline, average hemoglobin level (Hb) was 10.16 ± 1.12g/dL, serum ferritin 83.25 ± 96.55µg/L, TSAT 14.48 ± 6.72mg/dL and eGFR 24.21± 13.09ml/min/1.73m2. At 24 ± 8 weeks, Hb showed an increase of 1.31 ± 1.49 g/dL (p=0.001) and TSAT 10.68 ± 10.40% (p=0.001). Serum ferritin showed also an increase of 4.75 ± 180.53µg/L but did not reach statistical significance. The increase in Hb was observed uniformly across all stages of CKD. A Pearson correlation revealed a positive correlation between the variation of Hb and eGFR during the study follow-up period (r=0.310, p=0.008). A subgroup analysis was performed, patients were classified in 2 groups according to FCM dose. At baseline, there was no age, comorbidities or eGFR difference among groups. Patients treated with 1000mg had lower Hb (p=0.03) and serum ferritin (p=0.01). At 24±8 weeks both groups showed increases in Hb (p=0.001) and TSAT (p=0.001). Patients treated with 1000mg showed also a significant increase in ferritin (p=0.004). The Pearson correlation confirmed a positive correlation between the variation of Hb and eGFR in the group of patients treated with 1000mg (r=0.467, p=0.019) but not in the group treated with 500mg. Conclusion FCM was effective in the treatment of iron deficiency anemia in non-dialysis CKD stage 3 to 5 patients. In our population, the increase of Hb levels correlated with an improvement in eGFR in patients treated with higher doses of FCM, suggesting a positive impact of FCM on kidney function.

Soluble transferrin receptors and ferritin index in the diagnosis of iron deficiency in patients with spondyloarthritis and anemia

To assess the diagnostic value of the detection of soluble transferrin receptors (sTfR) and ferritin index (sTfR/log Fer) in patients with spondyloarthritis (SpA) and anemia for the revealing absolute iron deficiency (ID). The study included 68 patients with SpA: median age 39 [34; 47] years, men: 38 (55.9%). Hemogram, C-reactive protein levels and ferrokinetics parameters were assessed, including sTfR testing by the method of quantitative enzyme-linked immunosorbent assay (Monobind Inc., USA). We also calculated sTfR/log Fer. Based on ferrokinetics parameters and C-reactive protein levels, chronic disease anemia (CDA), iron deficiency anemia (IDA), or their combination (CDA/IDA) were diagnosed. CDA was diagnosed in 16 patients, CDA/IDA in 32 patients, and 20 patients had no anemia. An increase in sTfR concentration in patients with CDA/IDA (1.7 [1.4; 2.2] mg/L) compared with patients with CDA (1.5 [1.1; 1.7] mg/L, p0.05) was revealed. sTfR/log Fer in patients with CDA/IDA (0.93 [0.82; 1.24]) was higher than in patients with CDA (0.64 [0.48; 0.75], p0.0001). When evaluating the ROC curves, it was found that sTfR levels 1.39 mg/L and sTfR/log Fer levels 0.83 indicate the presence of absolute ID. The area under the ROC curve for sTfR was 0.72 (95% confidence interval 0.600.82, p0.001), for sTfR/log Fer 0.85 (95% confidence interval 0.740.92, p0.001). The sensitivity and specificity of sTfR/log Fer (75 and 83%, respectively) were higher compared with sTfR (53 and 81%, respectively). In patients with SpA having CDA/IDA, sTfR and sTfR/log Fer are statistically significantly increased. The results obtained indicate the possibility of diagnosing ID by using these parameters.

Prevalence and associated factors of iron deficiency in Spanish children aged 1 to 11 years.

Iron deficiency (ID) is the most common nutritional deficiency affecting children worldwide. Most traditional laboratory parameters to assess ID can be altered by infections or other inflammatory states, including obesity. The aims of this study were to determine the prevalence of ID in healthy children and to analyse associated factors, avoiding potential confounding factors through the use of serum transferrin receptor (sTfR), reticulocyte haemoglobin content and sTfR/log ferritin index. A cross-sectional population-based study was conducted on 951 children aged 1 to 11 years in Almería (Spain). ID was detected in 7.7% of children and iron deficiency anaemia in 0.9%. Multivariate analysis identified the following as independent risk factors: age under 5 years (OR: 2.2, 95% CI: 1.35-3.6); excessive consumption of cow's milk and dairy products (OR: 1.87, 95% CI: 1.13-3.1); and insufficient consumption of vegetables (OR: 2.7, 95% CI: 1.2-6.1).Conclusions: Using a combination of iron status parameters with greater discriminatory power than classical measures, this study detected a considerable iron deficiency prevalence in Spanish children. Younger children and specific dietary habits exhibit a particular risk for ID, so special attention should be paid to this population. What is Known: • Iron deficiency remains the most prevalent nutritional deficit worldwide, and children aged under 3 years are the most vulnerable to this condition. • Accurate assessment of iron status, based on a combination of biochemical indicators, can often be complicated. What is New: • Iron deficiency continues to present a health problem in Spanish children aged 1 to 11 years, considering the serum transferrin receptor and reticulocyte haemoglobin content for diagnosis. • Excessive consumption of dairy products and low consumption of vegetables are independent risk factors for iron deficiency.

Utility of sTFR/Ferritin index to differentiate iron deficiency anaemia and anaemia of chronic disease

Iron deficiency is a common condition that is usually diagnosed using conventional laboratory tests of iron status, such as serum ferritin and transferrin saturation. However, both ferritin and transferrin proteins are markedly influenced by inflammation, behaving as acute-phase reactants and making it difficult to differentiate between iron-deficiency anemia (IDA) and anemia of chronic disease (ACD). To assess the utility of sTfR/ Log ferritin Index to differentiate Iron deficiency anaemia and Anaemia of chronic disease. A cross-sectional study was conducted in the Department of Medicine, Victoria hospital and Bowring and Lady Curzon hospital, Bangalore Medical College and Research institute, Bangalore. A total of 150 blood samples were evaluated, i.e., 50 samples from iron deficiency anaemia group and 50 samples from patients with anaemia of chronic disorders &amp; 50 samples from healthy normal individual. In present study, samples are age matched with mean age of control 45.66±10.23, ACD 50.68±18.03, IDA 48.14±18.47. Hb, MCV, MCHC &amp; MCH were decreased in both the groups. However, the decrease in Hb &amp; MCV was much more in IDA as compared to ACD. Microcytosis was seen in 92% cases of IDA while it was observed in only 11% cases of ACD. sTfR/ log ferritin index was &amp;#62;1.5 in 80% of IDA. 90% of ACD and control subjects had sTfR/log ferritin index &amp;#60;1.5. sTfR levels were significantly higher in IDA (7.7± 5.8) as compared to the ACD cases (1.6 ±0.89) (p&amp;#60;0.001). sTfR/Log ferritin index is significantly higher in patients with Iron deficiency anemia (9.34±10.25) as compared to ACD (0.76±0.52) (p&amp;#60;0.001). sTFR/Log ferritin index indices is very useful in differentiating pure IDA, ACD and ACD with coexisting iron deficiency, thus providing a non-invasive alternative to bone marrow iron.

Role of Parenteral Iron Therapy in Gynaecologic Malignancies: A Review of Literature and Recommendations for Practice in a Cancer Centre in a Developing Country

Anaemia causes morbidity and mortality in cancer patients with negative impact on treatment outcome and prognosis. It has been a common practice to offer blood transfusion which comes with its own disadvantages. Therefore, alternative strategies are required to obviate the recurrent need for blood transfusion. Currently, the best treatment decisions for anaemia might be based on measurements of serum ferritin (SF), transferrin saturation (TSAT), soluble transferrin receptor (sTfR), ferritin index (FI = sTfR/log SF), hypochromic reticulocytes (CHR) and C-reactive protein (CRP). Parenteral iron therapy has advantages over oral route as compliance is the limiting factor in oral iron therapy and gastro-intestinal side effects are increased by oral route. A patient’s total body iron deficit can be calculated using the Ganzoni formula. Options for use of parenteral iron are iron dextran, iron sucrose and ferric gluconate. There are numerous trials which evaluate parenteral iron in cancer patients, but only a few evaluate them in gynaecologic malignancies. These trials conclude that usage leads to decreased transfusion rate and slow, steady and sustained rise in Hb level. Certain recommendations include safe and effective use of parenteral iron. Lowest Hb level for injectable iron should be 10 gm/dl. Post-surgical patients should be haemodynamically stable. Preparations can be given according to individual availability, cost and feasibility. Parenteral iron therapies improve time to target haemoglobin levels. They decrease need of blood transfusion. We recommend the use of intravenous iron therapy under supervision wherever feasible.

Effect of Sepsis on Iron Parameters in a Population with High Prevalence of Malnutrition and Iron Deficiency: A Cross-Sectional Case-Control Pilot Study.

There is lack of data on iron metabolism in critically ill sepsis children from population with high prevalence of iron deficiency (ID). The study was designed to study impact of sepsis on iron parameters in children with ID. Sepsis patients (age 6-59months) and their apparently healthy sibling/cousin as controls were enrolled in this case-control pilot study. Serum iron, TIBC, transferrin saturation, ferritin and sTfR were measured in the two groups. sTfR-Ferritin index was calculated. Patients (n = 134) were significantly underweight compared to controls (n = 54) (WAZ score < -2; 58% vs. 28%; p < 0.001). Serum iron and sTfR (mg/L) were lower [71.5 (51.0, 115.0) vs. 87.0 (64.5, 130.5), p = 0.068; 3.1 (2.1, 4.5) vs. 3.5 (2.8, 4.8), p = 0.026 respectively] while serum ferritin was higher [229 (94, 484.5) vs. 22 (9.2, 51); p < 0.001] in patients compared to controls. sTfR-Ferritin index was lower in patients [1.3 (0.8, 2.3) vs. 2.5 (1.8, 4.5); p < 0.001]. ROC AUC (patients vs. controls) were 0.89 (95% CI 0.83-0.95) and 0.76 (95% CI 0.68-0.85) for ferritin and sTfR-ferritin index respectively. Survivors and non-survivors were similar in terms of iron parameters. Sepsis-induced alterations in iron parameters among ID children are complex. Qualitatively it is similar (with quantitative differences) to non-ID adult population. Lack of correlation of iron parameters with mortality may be due to ID-associated immune dysfunction.

Effects of excess body weight and obesity on endotoxinemia and systemic inflammation in acute SARS-COV-2-associated lung injury

Objective. To evaluate the levels of lipopolysaccharide-binding protein, presepsin and systemic inflammation parameters in patients with SARS-CoV-2-virusinduced ung disease and overweight or obesity were studied. Methods. Fifty-five patients with PCR-positive SARS-CoV-2, age 44–70 years, hospitalized to infectious dis-ease wards were examined. Patients were divided into 3 groups: Group 1 (n=10) — patients with normal body mass index (BMI), Group 2 (n=19) — patients with ex-cess body weight (BMI &gt;25 kg/m2), Group 3 (n=26) — patients with grade 1 obesity (BMI &gt;30 kg/m2). A control group (n=20) was also selected. Levels of lipopolysac-charide-binding protein, presepsin, ferritin, and C-reac-tive protein in peripheral blood were tested. Findings.In all clinical groups of patients with new coronavirus infection who were admitted for inpatient treatment, a significant increase in all the studied parameters compared to the control group was detected. The highest LBP and CRP values were registered in the group of pa-tients suffering from 1st degree obesity. Presepsin and ferritin indices did not differ in the obese or overweight groups (p&gt;0.05), but were significantly higher com-pared to the 1st group and the control group (p&lt;0.05). Conclusions. Тhese results suggest that overweight and obesity lead to increased levels of circulating en-dotoxin as well as persistent systemic inflammation in patients with SARS-CoV-2 infection during the acute pe-riod of the disease

Diagnosis of Coronavirus Disease 2019 by Potential Laboratory Factors

Objectives: Coronavirus disease 2019 (COVID-19) associated by infection and high death rate. The unresolved questions about the fatality rate of COVID-19 are most probably related to cytokine storm syndrome. There is currently no specific medication. Understanding the pathogenic pathway of this disease will lead to production of treatment and decreases of death rate. The aim of this study is to investigate changes of peripheral blood parameters (Interleukin-6, Ferritin and hematological parameters) in COVID-19 patients, which may be beneficial in the management of patients. Methods: In this comparative study, we collected data of 270 subjects in two groups according RT-PCR test results, including 133 patients with COVID-19 and 137 patients with non-COVID-19, between March 20 and May 21, 2020. After obtaining the ethics code from the ethics committee, the clinical characteristics and laboratory findings of patients were collected from electronic Health Information Systems using data collection forms in Shahid Jalil hospital of Yasuj university of medical sciences. The data were analyzed by SPSS software version 20. Descriptive statistics and chi-square, Mann-Whitney U, Kruskal-Wallis tests and Pearson's correlation coefficient were used to analyse the data. Results: The enrolled COVID-19 patients consisted of 53.4% males and 46.6% females with the medium age of 45.56±18.55 years and there were 50.04% males and 49.6% females with the medium age of 45.59±17.0 years for non COVID-19 patients. There was no significant difference in the age and sex ratio between two populations under study. The proportion interstitial abnormalities evidenced by CT imaging in COVID-19 patients was 91.0%, while, 4.4% abnormalities were found in non-COVID-19 patients. The mean IL-6 and Ferritin levels and hematological parameters in two groups of patients with COVID-19 and non- COVID-19 were significantly different across all comparisons. There was a direct positively correlated between serum level of IL-6, Ferritin levels and hematological parameters including WBC, Lymphocytes, Neutrophils and Hb, except for platelets (negatively correlate), with COVID-19. Conclusion: In conclusion, inflammatory markers specifically IL-6 and Ferritin and hematological parameters (WBC, Lymphocytes, Neutrophils, Platelet and Hb) were correlated with the severity of COVID-19. Measurement of IL-6, Ferritin and hematological indices might be workable tests to diagnosis and prognosis of patients with COVID-19.

Reticulocyte parameters for monitoring anemia in patients with chronic kidney disease on peritoneal dialysi

ABSTRACT Introduction: Anemia is a complication with impact on morbidity and mortality in chronic kidney disease (CKD) patients. Current markers for the diagnosis and monitoring of anemia in CKD are limited by the interrelation between erythropoiesis, iron stores, inflammation, and the resistance to treatment with erythropoiesis stimulant agents (ESA). Objective: The aim of this study was to analyze the role of immature reticulocyte fraction (IRF) and hemoglobin concentration in reticulocytes (RET-He) by the hematology analyser Sysmex XN-5000 in the monitoring of CKD anemia in peritoneal dialysis patients. Methods: This was a prospective, observational multicenter study which compared IRF and RET-He with parameters recommended by the guidelines. Inflammatory biomarkers were analyzed by the Luminex® Multiplexing Instruments system. Thirty-five patients (59 ± 13 years old; 51% men) were included in the analysis. Results: Hemoglobin was 12.2 ± 2 g/dl; 87% had resistance to ESA. Patients with erythropoietin resistance index (ERI) in the upper quartile presented a significantly higher of IRF and a lower percentage of iron deficiency (12%) compared to ferritin (82%) and transferrin saturation index (STI) (51%). Interleukin-6 (IL-6) levels correlated with the percentage of medium fluorescence reticulocyte (MFR) (r = 0.45, p < 0.03). Hemoglobin values after 60 and 180 days were consistently higher in the group of patients with a IRF% lower than 10.5. Conclusion: IRF and RET-He may add value in the iron deficiency investigation, as well as in the identification of patients with ERI. Due to the restricted number of patients analyzed in this study, future studies should be encouraged in larger populations and with prospective follow-up, to validate our findings.

Insulin Resistance and Chronic Hepatitis C: Relationship With Serum Iron and Hepcidin.

Backgrounds and aimBesides the clinical evidence supporting insulin resistance in chronic hepatitis C (CHC) patients, the exact mechanism elucidating insulin resistance is still under discussion. The present study aimed to observe any relationship between serum hepcidin, serum iron, and insulin resistance in CHC patients.MethodologyA total of 54 individuals were recruited in this study, assorted into group A (CHC population with diabetes) and control group B (CHC population without diabetes). Both groups were tested for serum hepcidin, iron, ferritin, and serum glycemic indices (fasting blood glucose, serum insulin, and insulin resistance). Serum parameters were compared between diabetic and non-diabetic CHC patients by using the Mann-Whitney U test. Correlation analysis was done between serum hepcidin and serum iron, serum hepcidin, and insulin resistance, and serum iron and insulin resistance by applying the Spearman correlation test.ResultsDiabetic and non-diabetic CHC populations exhibited an iron profile of chronic illness, i.e., low serum iron and hepcidin along with normal ferritin levels. Also, the diabetic and non-diabetic CHC population exhibited normal serum insulin and insulin resistance. However, the fasting serum glucose of the diabetic CHC population was higher than normal. Correlation analysis indicated a negative significant correlation (rho=-0.404, p=0.036) between serum iron and insulin resistance among the diabetic CHC population.ConclusionOur study could not provide any mounting evidence in favor of insulin resistance in the chronic hepatitis C population via serum iron or hepcidin. Hepatitis C virus causing diabetes mellitus may have some etiology other than iron metabolism.

Anemia and iron deficiency in primigent parturients in a municipality of Brazilian west Amazon.

To analyze the prevalence of anemia and associated factors in primiparous parturient.Cross-sectional study conducted in a municipality of the Brazilian Western Amazon from July 2014 to December 2015. A convenience sample of 461 first-time pregnant women were interviewed. Data on their sociodemographic, clinical, obstetric, personal habits and nutritional status were collected. Anemia and iron depletion were measured by peripheral blood collection with hemoglobin, hematocrit, serum ferritin and transferrin saturation index. To test the association between the variables, the χ2 tests were applied and Poisson regression analysis with a 95% confidence interval was performed, and P < .05 values were considered significant. The Forward stepwise strategy was used to construct the adjusted model. These analyzes were performed using the STATA 14.0 program (College Station, TX, 2013).A higher risk of anemia was identified among adolescent; white; who had a partner; with unpaid occupation, with less than eight years of formal education. Residents in the countryside; smokers; who had more than six prenatal consultations and were overweight.Anemia was reported in 28.20% and iron depletion in 60.52% of parturient women. The variables studied did not have association with the anemia outcome, except alcohol consumption.

Ferritin index is a strong prognostic marker in adult hemophagocytic lymphohistiocytosis.

The relationship between ferritin levels and survival in adult hemophagocytic lymphohistiocytosis (HLH) has been evaluated in previous studies. However, Admission-to-discharge percentage ferritin reduction (named as ferritin index) level in adult patients with HLH has never been evaluated to predict 6-month survival. The demographic, laboratory and clinical information of 102 newly diagnosed adult HLH patients were collected. Regression analysis, receiver operating curve and Kaplan-Meier curves were analysed to explore the performance of ferritin levels. Ferritin index and discharge ferritin level were significantly different between survivour and non-survivour group (all P<.001). Ferritin index had the highest area under the curve (AUC) for predicting the survival (AUC=0.802, P<.001) followed by discharge ferritin (AUC=0.746, P<.001). Kaplan-Meier analysis showed a significant difference in survival according to optimum cutoff values of ferritin index≥10.19% (P<.001) or discharge ferritin≤1056.1μg/L (P<.001). Multivariate analysis confirmed that ferritin index and discharge ferritin are independent predictors of 6-month survival (ferritin index: odds ratio (HR) 6.237, 95% confidence interval (CI) 2.075-18.774, P=.001; discharge ferritin: HR 6.024, 95% CI 1.894-19.231, P=.002). In addition, the combination of a ferritin index≥10.19% and discharge ferritin≤1056.1μg/L had a significantly higher 6-month survival (P<.001). Ferritin index is a better predictor of 6-month survival than admission and discharges ferritin levels in adult patients with HLH.

Malnutrition and nutritional status in critically ill patients with enteral nutrition

BACKGROUND &amp; OBJECTIVE: The prevention of malnutrition is an important factor in the survival of critically ill patients with enteral nutrition. The present study aims to assess the nutritional status and its association with some blood-related markers in critically ill patients with enteral nutrition during hospitalization in the intensive care units (ICUs). METHODS: Totally, 110 patients participated in this study from the time of admission to discharge at five ICUs. The patients’ nutritional status was assessed by subjective global assessment (SGA), Acute Physiology and Chronic Health Evaluation and Albumin, Total Iron Binding Capacity (TIBC), Hemoglobin (Hb), Hematocrit (HCT), Ferritin, and Feas biochemical indices and anthropometric parameters. RESULTS: Malnutrition prevalence increased significantly on the day of discharge (83.6%) compared to the day of admission (41.8%), according to SGA (P &lt; 0.001). Hb, HCT, serum Fe decreased and ferritin, also TIBC were increased during hospitalization in ICU. The malnutrition risk predictors based on the logistic regression were low levels of Hb (OR = 0.6), HCT (OR = 0.9), Fe (OR = 0.9), Albumin (OR = 0.3) and High Ferritin level (OR = 1.006) on the admission day. Anemia of inflammation (AI) was observed during ICU stay. CONCLUSION: This study demonstrated that malnutrition is an increasing phenomenon in the ICU patients and the delay in patient’s enteral feeding had a direct influence in the prevalence of malnutrition on discharge day.