High Ferritin Levels Research Articles

Porphyria Cutanea Tarda (PCT) in a Patient, Treated with Hemodialysis after a Kidney Transplant Rejection Reaction: A Case Report

Porphyrias are a group of inherited metabolic disorders of haem biosynthesis, involving a deficiency in the enzyme uroporphyrinogen decarboxylase. In this case report we present a case of a patient with porphyria cutanea tarda (PCT). A 40-year-old man on hemodialysis after a kidney transplant rejection reaction, complaining of skin changes, with a history of smoking and alcohol intake. Treated with Fusidic acid Betamethasone cream, and erythropoietin. Porhyria cutanea tarda can be considered in a patient who complains of skin changes. History of alcohol intake, smoking, high ferritin levels, and increased hepatic markers can raise suspicion of disease. In patients with ESRD treatment with erythropoietin, SPF 50+ sun cream, Fusidic acid, and Betamethasone can be effective.

Unique characteristics of anti-MDA-5 associated dermatomyositis in Southern California with a large Hispanic population

ObjectivesThere is little to no data about the presentation and clinical course of anti-melanoma differentiation-associated gene-5 antibody (anti-MDA-5) dermatomyositis in a primarily U.S. Hispanic population. We describe the clinical course of anti-MDA-5 dermatomyositis in our majority Hispanic population. MethodsThis is a multicenter, retrospective case series of anti-MDA-5 dermatomyositis. Patients diagnosed with anti-MDA-5 dermatomyositis from June 2015 to March 2023 at four medical centers in Los Angeles, California, were included. Demographics and clinical characteristics were obtained. Descriptive statistics, Pearson's chi-squared, Fisher's exact, Wilcoxon rank sum, and Kruskal-Wallis tests were performed as applicable. ResultsThirty anti-MDA-5 dermatomyositis patients were included. Twenty-two (73 %) were Hispanic. Twenty-one patients (70 %) were female, with a median age of 40.5 years. Hispanic patients were diagnosed with anti-MDA-5 dermatomyositis at a younger age than non-Hispanic patients (p = 0.025). Inflammatory arthritis was prominent; more males were affected than females (p = 0.027). Thirteen patients (43 %) were amyopathic. Twenty-five patients (83.3 %) had evidence of interstitial lung disease (ILD), and a higher ferritin level was associated with ILD (p = 0.049). There were six deaths (20 %); five (17 %) were ascribed to rapidly progressive ILD. ConclusionILD was the most common presentation of anti-MDA-5 dermatomyositis in our cohort and was associated with higher ferritin levels. Hispanic patients had a younger age of diagnosis than non-Hispanic patients. Necrotic skin lesions and inflammatory arthritis were frequently seen. This is the first study looking at clinical phenotypes and outcomes of anti-MDA-5 dermatomyositis in a primarily Hispanic U.S. population. Future studies are needed to better understand the clinical manifestations (to promptly recognize and treat) of this population of anti-MDA-5 dermatomyositis.

Analysis of the Relationship of Serum Ferritin, Urate, and Some Hematological Parameters with Disease Activity in Gout Patients

Background and objectives: Gout is a type of arthritis. Acute gout is a common rheumatological disease that mostly affects first metatarsopharyngeal joint. Chronic gout is the condition that characterized by repeated episodes of acute gout. The objective of this study was to further explore the relationship between iron, ferritin, and other hematological markers with serum urate and gout. Methods: This cross sectional study was conducted in the Department of Rheumatology of Rizgary Teaching Hospital, Erbil, and Northern Iraqi Kurdistan. A total of 85 cases were enrolled in this study, 76 males and 9 females. There mean age (SD) was 46.6 (±11.2) years. All participants were known to have gout and fulfilled the criteria for diagnosis of gout. Serum ferritin, C-reactive protein, Serum iron, total iron binding capacity, and serum urate level were measured in addition to renal function tests and liver function tests were measured. Results: The mean (SD) for urate was 9.04 (±1.16) mg/dL, 76 (89.4%) patients with high serum uric acid had high level of ferritin in the blood meanwhile; 9 patients have normal ferritin level. There was a significant positive correlation (76 out of 85 patients) between serum ferritin level and serum urate (p<0.005 and rho=0.237). A positive correlation was found between C reactive protein and urate level, in contrast there was no correlation of iron level and urate level. Conclusion: The ferritin and C reactive protein levels were significantly high among gouty patients.

The relationship between increased iron load and respiratory function tests in patients diagnosed with transfusion dependent thalassemia

Aims: Thalassaemia syndromes are the most common single gene disorders affecting more than 200 million people worldwide. Beta thalassaemia (BT) is the most common cause of transfusion-dependent thalassaemia (TDT). It has been reported in studies that iron accumulation occurs in the lungs, especially in the alveolo-capillary membrane, and the frequency of parenchymal disease increases in patients receiving frequent blood transfusions. In our study, we aimed to investigate whether there is a correlation between iron overload and pulmonary function in patients with TDT.
 Methods: The study included 61 patients aged between 18 and 45 years with a diagnosis of TDT who were followed up in the hematology clinic of our tertiary care center between 2018 and 2023. Based on spirometry measurements, the pattern of respiratory impairment was defined and correlated with serum ferritin levels. 
 Results: The mean age of the 61 patients included in the study was 24.83±6.02 years and 33 were female and 28 were male. The mean ferritin value was 3150.88±2553.51 ng/ml. The annual number of transfusions was 15.39±1.90. According to the PFT results, mean FVC % value was 81.59±9.28, mean FEV1 % value was 82.11±7.6, mean FEV1/FVC % value was 102.55±7.63. Mean ferritin values were found to be significantly higher in patients diagnosed with TDT with restrictive lung pattern (p=0.004). 
 Conclusion: Our study showed that high ferritin levels are related to increased restrictive lung disease in the adult age group.

Assessing Iron Deficiency Anemia in Obese Adolescents and Identifying Contributing Factors

Objective: Clinical outcomes can be significant for obesity and iron deficiency, two public health issues for which adolescents are especially vulnerable. The aim of this study was to assess the iron parameters and blood vitamin B12 levels in obese adolescents and identify the contributing variables to the development of anemia. Material and Method: The present study involved a retrospective evaluation of 260 children (130 obese-130 control) who were admitted to the Ankara Pediatrics Haematology Oncology Training and Research Hospital, Pediatric Outpatient Clinics, between March 2013 and May 2015. Body mass index (BMI) above the 95th percentile for age and gender was required for inclusion in the study group, which included children aged 12 to 18 years without acute or chronic illnesses. Data from patient files were used to collect information on physical examination findings, sociodemographic characteristics, daily dietary status, and level of physical activity. All patients had evaluations for CRP, iron parameters, vitamin B12, and complete blood count. Results: The study revealed that the obese group had significantly higher serum ferritin levels (p=0.002) and lower serum iron and vitamin B12 levels (p=0.036 and 0.047, respectively) as compared to the control group. In the obese population, elevated BMI has been demonstrated to be correlated with elevated CRP levels. Conclusion: In obese children, low serum iron and high ferritin levels can be regarded as typical reference values. Furthermore, it was discovered that low vitamin B12 levels were not associated with nutrition in obese children, although they were at risk for developing low levels

Abstract A050: Ferritin, associated with worse overall survival in recurrent GBM, is reduced by combination of HDACi, ONC206 and radiation

Abstract Background: GBM is the most common primary brain malignancy with dismal prognosis. Current standard of care is chemoradiation&surgery. The main issue with GBM is the resistance & recurrence. GBM can have high Ferritin levels associated with disease progression & immunosuppression in the GBM TME. Ferritin light chain (FTL), a key protein in iron metabolism, is mutated in GBM leading to high ferritin levels (both light& heavy chain) & is associated with poor survival of (GBM) patients in part due to inhibition of ferroptosis. Panobinostat is a histone deacetylase inhibitor with antineoplastic & antiangiogenic effects in glioma. Imipridone ONC206 is under Phase I clinical development in treatment of adult & pediatric patients with newly diagnosed and/or recurrent primary brain tumors (NCT04732065 and NCT04541082).We investigated the novel combination of irradiation, Panobinostat and ONC206 with regard to GBM cell line sensitivity&ferritin levels. Materials & methods: We investigated cell viability and drug synergies of ONC206 plus Panobinostat with or without radiation in 4 human GBM cell lines at 72 hours. Changes in Ferritin level treatment in U87 & U251 cells were measured using cytokine profiling at 24 h time point. Information regarding recurrent cases of adult GBM from TCGA &GlioVis were used for survival data. Results: We previously have shown the synergy between Panobinostat, Irradiation and ONC206 (2023 AACR meeting). Treatment of U87 cells with Panobinostat and ONC206 at their IC50s +/- 4 Gy radiation at 24h time point led to reduction in secreted ferritin levels (Panobinostat alone: 26.3% decrease; ONC206 alone: 14.7% decrease; RT 4Gy alone 14.7% decrease; triple therapy: 32.2% decrease). In panobinostat treated U251 cells there was a 10% increase in ferritin at 24 h. ONC206 resulted in a reduction by 34.71%, 4 Gy RT caused a slight increase of 4% in ferritin amount while the triple showed 49.96% reduction in ferritin levels. mRNA expression of FTL gene (Ferritin Light Chain) is significantly higher in GBM tumors compared to normal brain tissue. From TCGA 17 cases of recurrent gliomas with FTL mutation were available with median survival of less than a year. In data from GlioVis of recurrent GBM cases 263 patients had high FTL with median survival of 12.6 months compared to 262 patients with low FTL with median survival of 14.9 months. Conclusions: GBM with high ferritin correlates with poor patient survival. FTL is associated with cell proliferation &angiogenesis of GBM cells & is protective from ferroptosis in glioma cells. ferritin may be a therapeutic target in recurrent & therapy resistant cases of GBM and ferroptosis modulating drugs &can be a novel treatment option. ONC206 & Panobinostat with irradiation is a novel combination & can be considered for temozolomide or radiation-resistant & recurrent cases. More studies are needed to investigate the mechanism & impact of ferritin in disease progression, therapy resistance& ferroptosis targeting therapeutics. We are currently exploring these directions including in vivo studies. Citation Format: Vida Tajiknia, Wafik El Deiry, Lanlan Zhou, William Macdonald, Praveen Srinivasan. Ferritin, associated with worse overall survival in recurrent GBM, is reduced by combination of HDACi, ONC206 and radiation [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A050.

Association of iron overload with infectious complications in liver transplant recipients: a systematic review and meta-analysis.

This study was performed to examine the possible association of iron overload with infectious complications and survival among liver transplant recipients. We conducted a systematic review and meta-analysis of studies published in the PubMed, Embase, Web of Science, and Cochrane Library databases up to September 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted to estimate the association of iron overload with infectious outcomes and overall survival after liver transplantation. Eight studies involving 2817 recipients met the inclusion criteria. Iron overload was strongly associated with an increased risk of infection after liver transplantation (HR, 1.66; 95% CI, 1.03-2.68). An increase in the serum ferritin level was associated with an increased risk of infection after liver transplantation (HR, 1.44; 95% CI, 1.09-1.91). Iron overload was a significant predictor of worse overall survival (HR, 1.35; 95% CI, 1.11-1.64). In addition, a high serum ferritin level was significantly associated with an increased risk of death (HR, 1.34; 95% CI, 1.10-1.64). Iron overload may be associated with a higher risk of infectious complications and a worse prognosis among liver transplant recipients.

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.

Role of epinephrine in attenuating cytokine storm, decreasing ferritin, and inhibiting ferroptosis in SARS-CoV-2

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019. It presents one of the most threatening pandemics in the history of humanity. The mortality and morbidity represent an unprecedented challenge to the modern medical era. SARS-CoV-2 results in acute respiratory distress syndrome, high concentrations of proinflammatory mediators, cytokine storm (CS) due to massive release of cytokines, hypercoagulation, and hemoglobin disintegration. Dysregulation of iron homeostasis, iron overload as indicated by high ferritin level, and ferroptosis are major factors in the pathogenesis of the disease. We report a case of SARS-CoV-2 in which the use of epinephrine (Epi) resulted in an unexpected attenuation of CS, decreasing ferritin level and inhibiting ferroptosis.Case presentationA 64-year-old male patient with a history of multiple medical comorbidities had been diagnosed with SARS-CoV-2. Further evaluation showed marked increase in inflammatory markers, severe hyperferritinemia, and lymphopenia in laboratory blood tests. The characteristic score of CS was strongly positive, and in addition to regular treatment, the patient received Epi due to development of acute generalized skin rash, severe itching, and edema of lips and tongue. Epi may have successfully terminated not only the acute cutaneous condition, but also have attenuated CS, decreased ferritin level, and other inflammatory markers in addition to complete patient’s recovery.ConclusionEpinephrine may attenuate CS and inhibit ferroptosis which is an iron-dependent, non-apoptotic mode of cell death. Epi interacts with ferric and/or ferrous iron and built a stable complex that impedes activation of beta-adrenergic receptors. Epi may cause marked decrease of ferritin and other inflammatory markers. Epi may be used to decrease iron overload which is associated with many medical diseases like type 2 diabetes mellitus and cardiometabolic diseases such as coronary heart disease and cerebrovascular disease. As a new clinical indication extensive studies are required for further assessment and possible therapeutic uses.

High Serum Ferritin Level to Predict the Severity of Dengue Viral Infection

This study aims to identify common opportunistic infections and their prevalence among people living with HIV in Osogbo, Osun state, who are receiving treatments for the HIV virus, which has spread widely.A mixed study design was employed, including a hospital-based retrospective study and a Key Informant Interview. The retrospective study involved 280 HIV patients at State Specialists Hospital Asubiaro SSHA Osogbo, Nigeria, and collected socio-demographic, opportunistic infection diagnosis, and viral load test results. The study also included a Key Informant Interview with six health workers in the HIV care unit. Quantitative data was analyzed using descriptive statistics and Chi-square tests, while qualitative data was analyzed using a thematic approach.The study reveals that the majority of People Living with HIV are females (77.1%), with 69% unemployed and 28.6% employed. Most are married (82.5%). In 2020, 58.2% achieved viral suppression, while in 2021, 65.7% and 69% achieved it. Common opportunistic infections include tuberculosis, pruritus, oral candidiasis, and herpes zoster. The prevalence of opportunistic infections decreased from 9.0% to 7.6% between January 2020 and May 2022.The prevalence of opportunistic infections in the study was low, which is due to the high preventive measures employed by the health workers in the hospital. Hence adherence to HAART (Highly Active Antiretroviral Therapy) medications helps to maintain healthy living for People living with HIV

Can serum ferritin serve as a biomarker for the prognosis of gynecological malignant tumors? A retrospective cohort study.

It is widely accepted that there is a strong relationship between iron levels and cancer. This study aimed to investigate the relationship between serum ferritin levels and the severity and prognosis of gynecological malignant tumors. This retrospective study included patients with gynecological malignant tumors at Sir Run Run Shaw Hospital in the Department of Obstetrics and Gynecology from January 2013 to June 2019. Patients were grouped according to their serum ferritin level: low (< 13μg/L), normal (13-150μg/L), and high (> 150μg/L). Correlation analyses were performed between serum ferritin level and other factors. Cox univariable and multivariable analysis and Kaplan-Meier survival curves were used to assess the impact of ferritin on survival in patients with gynecologic tumors. The 402 total patients were divided into a low (n= 37), normal (n= 182), and high (n= 183) ferritin level group. Correlation analyses were performed that WBC, MCV, CRP, CA125, and CA153 were significantly positively correlated with serum ferritin level. The Kaplan-Meier survival curves revealed that of the three groups analyzed, the high serum ferritin level group had a significantly shorter survival time versus the normal and low serum ferritin level groups (log-rank P= 0.003). Univariable Cox regression analysis identified that patients with high serum ferritin levels had a significant correlation with risk of death compared to the patients with lower and normal serum ferritin levels. Serum ferritin was not found to be significant (HR = 0.792, 95% CI: 0.351-1.787, P= 0.574) in the multivariable Cox analysis. Although this study did not find serum ferritin to be a significant independent prognosis indicator in gynecological malignant tumors, this study did identify that gynecological malignant tumor patients with high serum ferritin levels have significantly less survival time than patients with low or normal serum ferritin levels.

Endothelial dysfunction and cardiovascular risk in post-COVID-19 patients after 6- and 12-months SARS-CoV-2 infection.

SARS-CoV-2 infection causes severe endothelial damage, an essential step for cardiovascular complications. Endothelial-colony forming cells (ECFCs) act as a biomarker of vascular damage but their role in SARS-CoV-2 remain unclear. The aim of this study was to assess whether the number of ECFCs and angiogenic biomarkers remained altered after 6 and 12-months post-infection and whether this imbalance correlated with the presence of long-COVID syndrome and other biological parameters measured. Seventy-two patients were recruited at different time-points after overcoming COVID-19 and thirty-one healthy controls. All subjects were matched for age, gender, BMI, and comorbidities. ECFCs were obtained from peripheral blood and cultured with specific conditions. The results confirm the presence of a long-term sequela in post-COVID-19 patients, with an abnormal increase in ECFC production compared to controls (82.8% vs. 48.4%, P < 0.01) that is maintained up to 6-months (87.0% vs. 48.4%, P < 0.01) and 12-months post-infection (85.0% vs. 48.4%, P < 0.01). Interestingly, post-COVID-19 patients showed a significant downregulation of angiogenesis-related proteins compared to controls indicating a clear endothelial injury. Troponin, NT-proBNP and ferritin levels, markers of cardiovascular risk and inflammation, remained elevated up to 12-months post-infection. Patients with lower numbers of ECFC exhibited higher levels of inflammatory markers, such as ferritin, suggesting that ECFCs may play a protective role. Additionally, long-COVID syndrome was associated with higher ferritin levels and with female gender. These findings highlight the presence of vascular sequela that last up to 6- and 12-months post-infection and point out the need for preventive measures and patient follow-up.

Predicting factors of survival rates among alpha- and beta-thalassemia patients: a retrospective 10-year data analysis

BackgroundThalassemia is a genetic hemoglobinopathy in which a defective globin chain can cause transfusion-dependent anemia and other complications. As genotype interactions lead to variations in the clinical course among patients with thalassemia, clinical factors may help predict survival in the types of thalassemia complicated by gene interactions.AimThis study aimed to determine the clinical factors associated with survival in patients with thalassemia. We retrospectively reviewed the medical records of patients with thalassemia older than 15 years between 2002 and 2020 that were available at the Rajavithi Hospital. Data on the clinical parameters, laboratory tests, treatments, and survival status were collected and analyzed.ResultsOf the 478 thalassemia patients included, 68.8% were women, and the mean age was 41 ± 17 years. The most common type of thalassemia was β-thalassemia (53.3%). Male sex, low body mass index, the thalassemia type, comorbidities, low hemoglobin level, high ferritin level, and regular blood transfusion were significantly associated with short-term survival. However, only the thalassemia type (β-thalassemia, p = 0.048) and the co-inheritance of the α- and β-thalassemia genotypes (p = 0.03) were independently associated with death. The overall survival rates among patients with α-thalassemia, β-thalassemia, and co-inheritance of the α- and β-thalassemia genotypes were 98.1%, 90.6%, and 75.0%, respectively. The death rate was 6.3%, and the most common cause of death was infection.ConclusionThe thalassemia genotype was a predictive factor of survival, and co-inheritance of the α- and β-thalassemia genotypes results in a shorter-term survival compared with other types, especially transfusion-dependent thalassemia. These results can be applied in clinical settings to predict and possibly extend the life expectancy of patients with thalassemia.

Ferritin-mediated neutrophil extracellular traps formation and cytokine storm via macrophage scavenger receptor in sepsis-associated lung injury

BackgroundSepsis is a severe systemic inflammatory disorder manifested by a dysregulated immune response to infection and multi-organ failure. Numerous studies have shown that elevated ferritin levels exist as an essential feature during sepsis and are able to suggest patients’ prognoses. At the same time, the specific mechanism of ferritin-induced inflammatory injury remains unclear.MethodsHyper-ferritin state during inflammation was performed by injecting ferritin into a mouse model and demonstrated that injection of ferritin could induce a systemic inflammatory response and increase neutrophil extracellular trap (NET) formation.Padi4−/−, Elane−/− and Cybb−/− mice were used for the NETs formation experiment. Western blot, immunofluorescence, ELISA, and flow cytometry examined the changes in NETs, inflammation, and related signaling pathways.ResultsFerritin induces NET formation in a peptidylarginine deiminase 4 (PAD4), neutrophil elastase (NE), and reactive oxygen species (ROS)-dependent manner, thereby exacerbating the inflammatory response. Mechanistically, ferritin induces the expression of neutrophil macrophage scavenger receptor (MSR), which promotes the formation of NETs. Clinically, high levels of ferritin in patients with severe sepsis correlate with NETs-mediated cytokines storm and are proportional to the severity of sepsis-induced lung injury.ConclusionsIn conclusion, we demonstrated that hyper-ferritin can induce systemic inflammation and increase NET formation in an MSR-dependent manner. This process relies on PAD4, NE, and ROS, further aggravating acute lung injury. In the clinic, high serum ferritin levels are associated with elevated NETs and worse lung injury, which suggests a poor prognosis for patients with sepsis. Our study indicated that targeting NETs or MSR could be a potential treatment to alleviate lung damage and systemic inflammation during sepsis.CG19NQAB-3s1ZkbgUbzmoXVideo

Study of serum ferritin levels in various phases of dengue in pediatric dengue patients admitted in a tertiary hospital

Background: Dengue is a cause of public health concern with case fatality rate of 1%. Ferritin is an acute-phase reactant which is produced in response to infection and inflammation. The aim of this study is to evaluate serum ferritin levels in various phases of dengue in pediatric dengue patients. Methods: A hospital-based, prospective, and observational study was done involving 30 dengue cases diagnosed by positive NS1 antigen or dengue specific serology (capture enzyme-linked immunosorbent assay). Serum ferritin was estimated by electrochemiluminescence in all three phases of dengue. Clinical and platelet count monitoring was done daily; respectively. All children classified as dengue with or without warning signs and severe dengue according to the World Health Organization guidelines on diagnosis treatment, prevention, and control of dengue, 2009. Results: Out of total of 30 children with mean age of the children were 7 years, and 61% were male who were majority. High serum ferritin levels were noted during critical phase. Eight children with dengue shock syndrome and one with acute respiratory distress syndrome were managed in intensive care unit as compared to non-severe dengue with statistically significant difference as p&lt;0.05. Increase in serum ferritin is associated with severe thrombocytopenia. The mean hospital stay duration was found to be 5±3 days (mean ± standard deviation). Conclusion: Serum ferritin levels taken on admission can serve as a reliable and cost-effective biomarker in the assessment and in predicting the severity of dengue fever. Serum ferritin levels may help in identifying an uncomplicated dengue illness, from that of patients who may require inpatient admission/intensive critical care.

Two versus three doses of COVID-19 vaccine and post-vaccination COVID-19 infection in hemodialysis patients

Background and aimPatients with chronic kidney disease including those undergoing hemodialysis (HD) constitute a particularly challenging group regarding COVID-19 vaccination. The present study aimed to compare the rate of reinfection after two and three doses of Sinopharm COVID-19 vaccine in HD patients. Patients and methodsThe study included 80 HD patients who received three doses of Sinopharm COVID-19 vaccine. In addition, there were another 80 patients who received only two doses of the vaccine. Patients in the latter group were selected based on propensity matching score with 1:1 ratio. Patients were monitored for post-vaccination COVID-19 infection using PCR examination of nasopharyngeal swabs. Patients were also monitored for post-vaccination complications including general complaints (headache, fever, fatigue), injection site complaints (arm pain, swelling, itching, rash), musculoskeletal complaints (muscle spasm or pain, joint pain) and others. All patients were followed for six months. ResultsThe present study included 80 patients submitted to COVID-19 vaccination with two doses of Sinopharm vaccine (GI) and other 80 patients who received three doses of the same vaccine (GII). At the end of follow up, 11 patients (13.8 %) in GI caught COVID-19 infection. In contrast, no patient in GII had infection (p<0.001). Comparison between patients who had COVID-19 infection and those without infection revealed that the former subgroup had significantly lower BMI (23.3 ± 2.3 versus 27.5 ± 8.1 Kg/m2), higher frequency of associated Hepatitis C (HCV) infection (54.6 % versus 2.9 %, p<0.001) and higher serum ferritin levels [median (IQR): 1101.0 (836.0-1564.0) versus 675.0 (467.0-767.7) ng/mL, p=0.01]. Binary logistic regression analysis identified high serum ferritin levels [OR (95% CI): 0.014 (0.001-0.15), p<0.001] and associated HCV infection [OR (95% CI): 0.99 (0.98-1.01), p=0.02] as significant predictors of post-vaccination COVID-19 infection in multivariate analysis. ConclusionsA three dose regime of Sinopharm COVID-19 vaccine associated with significantly lower rate of reinfection COVID-19 infection in HD patients. Infected patients had significantly lower BMI, higher frequency of HCV and higher ferritin levels.

Ferritin as an Effective Predictor of Neurological Outcomes in Children With Acute Necrotizing Encephalopathy

BackgroundAcute necrotizing encephalopathy (ANE) is a fulminant disease with poor prognosis. Cytokine storm is the important phenomenon of ANE that affects the brain and multiple organs. The study aimed to identify whether hyperferritinemia was associated with poor prognosis in patients with ANE. MethodsAll patients with ANE had multiple symmetric lesions located in the bilateral thalami and other regions such as brainstem tegmentum, cerebral white matter, and cerebellum. Neurological outcome at discharge was evaluated by pediatric neurologists using the Pediatric Cerebral Performance Category Scale. All risk factors associated with poor prognosis were further analyzed using receiver operating characteristic curve analysis. ResultsTwenty-nine patients with ANE were enrolled in the current study. Nine (31%) patients achieved a favorable neurological outcome, and 20 (69%) patients had poor neurological outcomes. results The group of poor neurological outcome had significantly higher proportion of shock on admission and brainstem involvement. Based on multivariate logistic regression analysis, ferritin, aspartate aminotransferase (AST), and ANE severity score (ANE-SS) were the predictors associated with outcomes. The appropriate cutoff value for predicting neurological outcomes in patients with ANE was 1823 ng/mL for ferritin, 78 U/L for AST, and 4.5 for ANE-SS. Besides, comparison analyses showed that higher level of ferritin and ANE-SS were significantly correlated with brainstem involvement (P < 0.05). ConclusionsFerritin may potentially be a prognostic factor in patients with ANE. Hyperferritinemia is associated with poor neurological outcomes in patients with ANE and ferritin levels more than 1823 ng/mL have about eightfold increased risk of poor neurological outcome.

Association between Body Iron Status and Cognitive Task Performance in a Nationally Representative Sample of Older Adults.

Iron is an essential micronutrient that is necessary for proper cognitive function. However, the dose-response relationship between body iron status and cognitive function remains unclear. The objective of this study was to investigate the association between serum ferritin concentrations, an indicator of body iron status, and cognitive function in older adults. Based on the National Health and Nutrition Examination Survey (NHANES) 1999 -2002 in the United States, nationally representative data was collected from 2,567 adults aged 60 years and older who had objectively measured serum ferritin levels and cognitive performance. High ferritin levels were defined as a serum ferritin level >200 ng/mL in women and >300 ng/mL in men. Low ferritin levels were defined as a serum ferritin level <30 ng/mL. The digit symbol substitution test (DSST) was employed to assess cognitive function. Multivariable logistic regression analyses with survey weights were performed after the DSST was dichotomized at the median score. The weighted prevalence of adults with normal, low, and high serum ferritin levels were 73.98%, 9.12%, and 16.91%, respectively. A U-shaped association between serum ferritin concentrations and cognitive task performance was observed. After adjusting for demographic, socioeconomic, lifestyle, and C-reactive protein factors, the odds ratio (95% confidence intervals) for lower cognitive performance was 1.39 (1.11, 1.74) in adults with high ferritin levels and 1.38 (0.86, 2.22) in adults with low ferritin levels, compared with those with normal ferritin levels. The association between serum ferritin levels and lower cognitive performance was stronger in adults aged 60 to 69 years old than those aged 70 years and older. In conclusion, in a nationally representative sample of older adults in the United States, a high serum ferritin level was significantly associated with worse cognitive task performance. Thus, the relationship between low serum ferritin concentrations and cognitive task performance warrants further investigation.

A preliminary study on the association between prognostic nutritional index and neutrophil-to-lymphocyte ratio with nutritional status and inflammation in febrile children's susceptibility to seizures.

The aim of this study was to evaluate the association between nutritional status, inflammation, and susceptibility to seizures in febrile children. This observational single-center study was carried out from January 2020 to December 2023 with 324 children aged 6 months and 6 years; 106 were diagnosed with febrile seizure, 108 were febrile children, and 110 were healthy controls. The prognostic nutritional index and neutrophil-to-lymphocyte ratio were calculated, and the cutoff threshold was established through receiver operating characteristics. The study utilized correlation and univariate-multivariate logistic regression analysis. The comparison between simple and complex febrile seizure was conducted to analyze differences. The optimal cutoff values were identified as 61.25 for prognostic nutritional index and 1.04 for neutrophil-to-lymphocyte ratio. Our findings showed a significant negative association between febrile seizure and platelet count, high C-reactive protein, and high ferritin levels. Additionally, the febrile seizure group showed a significant positive correlation with high neutrophil-to-lymphocyte ratio values (≥1.04) and body temperature (≥38). Our findings revealed that high neutrophil-to-lymphocyte ratio, high C-reactive protein, and age less than 18 months were independently associated with seizure susceptibility in febrile children. High neutrophil-to-lymphocyte ratio values and low prognostic nutritional index scores may serve as novel surrogate independent factors for seizure susceptibility in febrile children. Febrile children who are less than 18 months old are more prone to experience seizures than older febrile children. Moreover, there was a correlation between febrile seizures and elevated C-reactive protein levels and neutrophil-to-lymphocyte ratio values.

Impact of Age on Predictive Capabilities of Ferritin, Ferritin-Hemoglobin Ratio, IL-6, and sIL-2R for COVID-19 Severity and Mortality.

The study aimed to establish the impact of age on the predictive capability of ferritin, ferritin-hemoglobin ratio (FHR), IL-6, and sIL-2R in COVID-19 patients. Compared to patients with moderate condition, patients with severe condition had higher ferritin level (441.0 [188.0-829.8] ng/mL vs 281.0 [172.0-388.0] ng/mL, p = 0.002), sIL-2R level (6.0 [4.7-9.0] pg/mL vs 5.3 [3.7-6.9] pg/mL, p = 0.020), FHR (38.4 [15.1-63.4] vs 22.0 [12.1-32.1], p = 0.002). The area under the curves (AUC) for discriminative capabilities of the following biomarkers for severe condition were assessed in patients aged &lt;65 years and patients aged ≥65 years: ferritin (AUC = 0.585, p = 0.309 vs AUC = 0.683, p = 0.002), FHR (AUC = 0.589, p = 0.302 vs AUC = 0.688, p = 0.002), IL-6 (AUC = 0.503, p = 0.972 vs AUC = 0.647, p = 0.019), and sIL-2R (AUC = 0.549, p = 0.552 vs AUC = 0.646, p = 0.017). Also AUCs for discriminative capabilities for in-hospital mortality were compared in patients aged &lt;65 years and ≥65 years: ferritin (AUC = 0.607, p = 0.628 vs AUC = 0.661, p = 0.105), FHR (AUC = 0.612, p = 0.621 vs AUC = 0.688, p = 0.002), IL-6 (AUC = 0.580, p = 0.724 vs AUC = 0.695, p = 0.016), and sIL-2R (AUC = 0.620, p = 0.491 vs AUC = 0.695, p = 0.029). Thus, ferritin, FHR, IL-6, and sIL-2R didn't show acceptable predictive value for severe condition and lethal outcome in patients aged &lt;65 years but had high predictive value for lethal outcome in patients aged ≥65 years.