High Ferritin Levels Research Articles

Relationship between serum ferritin level and outcome of septic shock in children

Background Sepsis is a life-threatening organ dysfunction caused by dysregulation of the immune system against infection. Sepsis that leads to septic shock is one of the causes of morbidity and mortality in children who are treated in intensive care and inpatient rooms. Ferritin is a protein whose synthesis is increased in inflammatory and infectious conditions and can be a marker of active infection. The cut off ferritin in septic shock was not established and not absolutely clear in our patients. Objective To determine the cut-off value of ferritin levels in patient with septic shock and the relationship between high serum ferritin levels with poor outcome (mortality) in pediatric patients with septic shock. Methods This study used an observational-analytic design with prospective cohort study design. The research was conducted in pediatric ward, Prof. Dr. I.G.N.G. Ngoerah hospital from October 2021 to August 2022. Data analysis was done in 2 steps, first by using receiver operator characteristic curves to find the optimal cut-off point value and the second step was bivariate and multivariate analysis to determine the relationship between ferritin levels and the outcome of septic shock in children. The significance level (α) of this study was set with probability value less than 0.05. Results This study involved 76 subjects, 49 subjects died and 27 subjects survive. The Area Under Curve of ferritin levels from ROC curve obtained was ​​83.7% (p=0.001, 95% CI 74.2%-93.1%). The cut off for ferritin level 660.78 ng/ml gave sensitivity 85.7% and specificity 77.8% for mortality in patients with septic shock. The value of ferritin levels ³ 660.78 generate mortality risk 39.50 times (95% CI 8.057 – 183.422) in pediatric patients with septic shock. Conclusion Higher ferritin levels can increase the risk of mortality in pediatric septic shock patients.

Association between iron status markers and kidney outcome in patients with chronic kidney disease

Several studies conducted in patients with various stages of chronic kidney disease (CKD) have investigated the association of iron status markers, such as transferrin saturation (TSAT) and serum ferritin, with kidney outcomes. However, the associations were inconsistent and remain strongly debated. Therefore, we aimed to investigate whether TSAT and serum ferritin levels were associated with kidney outcome in such a population. In this study, 890 patients who were admitted for the evaluation of and education for CKD were prospectively followed. Primary kidney outcome was a composite of doubling of serum creatinine, end-stage kidney disease, or death due to kidney failure. Participants were divided into quartiles (Q1–Q4) according to TSAT or serum ferritin levels. During a median follow-up period of 2.8 years, kidney events occurred in 358 patients. In the multivariable Cox analyses, compared with Q3 of TSAT, the hazard ratios (95% confidence intervals) for Q1, Q2, and Q4 were 1.20 (0.87, 1.66), 1.38 (1.01, 1.87), and 1.14 (0.82, 1.59), respectively. Compared with Q2 of serum ferritin, lower and higher quartiles had a significantly increased risk for kidney outcome; hazard ratios (95% confidence intervals) for Q1, Q3, and Q4 were 1.64 (1.18, 2.27), 1.71 (1.24, 2.37), and 1.52 (1.10, 2.10), respectively. A Fine-Gray model with death before kidney events as a competing risk showed results similar to the above. In CKD, lower and higher ferritin levels were independent risk factors for kidney disease progression.

Clinical and laboratory features associated with macrophage activation syndrome in Still’s disease: data from the international AIDA Network Still’s Disease Registry

To characterize clinical and laboratory signs of patients with Still’s disease experiencing macrophage activation syndrome (MAS) and identify factors associated with MAS development. Patients with Still’s disease classified according to internationally accepted criteria were enrolled in the AutoInflammatory Disease Alliance (AIDA) Still’s Disease Registry. Clinical and laboratory features observed during the inflammatory attack complicated by MAS were included in univariate and multivariate logistic regression analysis to identify factors associated to MAS development. A total of 414 patients with Still’s disease were included; 39 (9.4%) of them developed MAS during clinical history. At univariate analyses, the following variables were significantly associated with MAS: classification of arthritis based on the number of joints involved (p = 0.003), liver involvement (p = 0.04), hepatomegaly (p = 0.02), hepatic failure (p = 0.01), axillary lymphadenopathy (p = 0.04), pneumonia (p = 0.03), acute respiratory distress syndrome (p < 0.001), platelet abnormalities (p < 0.001), high serum ferritin levels (p = 0.009), abnormal liver function tests (p = 0.009), hypoalbuminemia (p = 0.002), increased LDH (p = 0.001), and LDH serum levels (p < 0.001). At multivariate analysis, hepatomegaly (OR 8.7, 95% CI 1.9–52.6, p = 0.007) and monoarthritis (OR 15.8, 95% CI 2.9–97.1, p = 0.001), were directly associated with MAS, while the decade of life at Still’s disease onset (OR 0.6, 95% CI 0.4–0.9, p = 0.045), a normal platelet count (OR 0.1, 95% CI 0.01–0.8, p = 0.034) or thrombocytosis (OR 0.01, 95% CI 0.0–0.2, p = 0.008) resulted to be protective. Clinical and laboratory factors associated with MAS development have been identified in a large cohort of patients based on real-life data.

Evaluation of COVID-19 Pneumonia in Children According to the Original Strain, Alpha, Delta and Omicron Variants

Objective: As known, COVID-19, stemming from the SARS-CoV-2 virus, exhibits distinct clinical patterns across various variants. This research endeavors to comprehensively analyze the variations in clinical presentations between these variants and the original strain, particularly in pediatric COVID-19 pneumonia cases. Materials and Methods: Patients diagnosed with COVID-19 pneumonia who were admitted to Mersin City Research and Training Hospital between June 2020-2022, were included in the study. Clinical and laboratory data of the patients were evaluated according to their variant status. Results: 56% (n=62) of 110 pediatric patients were female, and their average age was 11±5.9 (median 13). 31%(n=34) of the patients were infected with the original strain, 20% (n=22) were alpha, 40% (n=44) were delta, and 9% (n=10) were omicron variant. 6% (n=7) of the patients were asymptomatic, 11% (n=12) were mildly symptomatic, 76% (n=83) were moderate (respiratory distress), and 7% (n=8) were severe clinical patients requiring mechanical ventilation. Fever and shortness of breath were most frequently seen in delta, and cough in alpha variant (p=0.0001;p=0.014;p=0.039,respectively). The most severe disease detected in omicron was alpha, delta and original virüs (p=0.001). No relationship detected between the laboratory values of the patients and the variant status (p&gt;0.05). When patients were compared based on radiological severity, no significant differences were found between the variants (p=0.214). However, when cases were classified according to pneumonia severity, regardless of the variant status, higher levels of ferritin (p=0.0001) and CRP (p=0.037) were observed, while lymphocyte count (p=0.009) decreased with increasing pneumonia severity. It's noteworthy that no patient fatalities occurred. Conclusion: In our study, the most severe clinical picture was shown in the omicron variant, followed by the alpha variant. But, omicron cases were limited, and it is important to examine variants in a larger population.

Increased risk of poor clinical outcome in COVID-19 patients with diabetes mellitus and in-hospital mortality predictors: Aretrospective cohort from a tertiary hospital in Indonesia.

To determine association between diabetes in confirmed cases of COVID-19 and intensive care admission and in-hospital mortality, evaluate several laboratory parameters as mortality predictor and develop predictors of in-hospital mortality among diabetics with COVID-19. This retrospective cohort recruited all cases of COVID-19 hospitalized in Fatmawati General Hospital from March to October 2020. Inclusion criterion was RT-PCR confirmed cases of COVID-19 who aged 18 years and older while exclusion criteria were incomplete medical record or cannot be found and pregnant women. We enrolled 506 participants to this study with median age of 51 years (IQR:22), female (56.32%), and diabetes (28.46%). Diabetes increased intensive care admission (adjusted OR: 2.57; 95% CI: 3.52-10.43) and in-hospital mortality (adjusted OR: 2.50; 95% CI: 1.61-3.89). In predicting in-hospital mortality, ferritin and lactate dehydrogenase offered an acceptable discrimination, AUC: 0.71 (95% CI: 0.62-0.79) and AUC: 0.70 (95% CI: 0.61-0.78), respectively. The optimal cut-off of predicting mortality for ferritin was 786 g/mL and for LDH was 514.94 u/L. Factors include age above 70 years old, RBGs level on admission above 250 mg/dL or below 140 mg/dL, ferritin level above 786 ng/mL and presence of ARDS increased the odds of mortality among individuals with diabetes. Diabetes increases risk intensive care admission and in hospital mortality in COVID-19. Multivariate analysis showed that older age, RBG on admission, high ferritin level, presence of ARDS increased the odds of mortality among individuals with diabetes.

D-dimer and Ferritin Levels in Prediction of COVID-19 Severity

Abstract BACKGROUND: The most common cause of upper respiratory tract infection is coronavirus, which has a crown appearance due to the existence of spikes on its envelope. D-dimer levels in the plasma have been considered a prognostic factor for COVID-19 patients. AIM OF THE STUDY: The aim of the study is to demonstrate the role of COVID-19 on coagulation parameters D-dimer and ferritin with their association with COVID-19 severity and disease progression in a single-center study. PATIENTS AND METHODS: This study included 200 COVID-19 patients in a private single center from January 01, 2021, to January 01, 2022, in Baghdad-Iraq. D-dimer and ferritin were analyzed in those patients and evaluated their association with the need for oxygen therapy and intensive care unit (ICU) admission. RESULTS: Two hundred COVID-19 patients met the criteria for inclusion in this research. The total mean age of all patients was 60.1 ± 11.6 years and the sex distribution was 130 (65%) males and 70 (35%) females. Regarding D-dimer and ferritin, there were significantly higher values in patients in respiratory care units (4748 ± 7.2) (215.7 ± 4.2) (P = 0.0001) in comparison with another group who did not need oxygen or ICU admission (345 ± 3.6) (98.4 ± 1.7), respectively. CONCLUSIONS: High levels of D-dimer and ferritin may be used as tools to predict unfavorable clinical outcomes of the disease and poor prognosis.

Flow Cytometric Analysis of Lymphocyte Subsets of Covid-19 Patients from A Single Centre in Turkey

Background:&#x0D; Lymphocyte counts have been shown to negatively correlate with the severity and different outcomes in Covid-19. The aim of this single centre study is to analyse the distribution of lymphocyte subsets in response to SARS-CoV-2 infection and its relation to the severity, course and prognosis of the disease.&#x0D; Methods:&#x0D; Blood samples were obtained from 67 consecutive patients between April 2020 and July 2020. Data on other laboratory parameters, and clinical course were collected retrospectively from patient files and patints were defined to have as severe or non-severe (mild/moderate) disease. Leukocyte subsets to be studied were identified by using flow cytometric analysis. Patients were allocated into 3 groups based on the day of blood sample collection for the flow cytometric analysis: Days 0-7, Days 8-14 and Days &gt;14 as Group I, Group II and Group III, respectively. In 10 available of 67 patients an additional flow cytometric analysis was done 7-10 days after the initial sampling.&#x0D; Results:&#x0D; Lower total lymphocyte, CD3 positive, CD4 positive and B-cell counts were identified in severe infection compared to non-severe infection group which were also correlated with high serum CRP, D-dimer and ferritin levels. NK and monocyte counts were not different between the two groups. Activation markers CD38 and HLA-DR on CD4 and CD8 positive lymphocytes also were not different in either group. &#x0D; Conclusion:&#x0D; CD3 and CD4 lymphopenia were lower in accordance with previous studies and were associated with severe disease. The expectancy of high activation markers was not met. Future studies with detailed subgroup analyses at different time-points, and immune profiling after vaccination as well as during new infection in vaccinated patients will shed more light on our general knowledge of the immune response to COVID-19 and viruses in general.

The clinical characteristics of subcutaneous and mediastinal emphysema in anti-melanoma differentiation-associated 5 positive dermatomyositis associated with interstitial lung disease.

To investigate the clinical characteristics of subcutaneous emphysema (SE) and mediastinal emphysema (ME) occurring in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis associated with interstitial lung disease (anti-MDA5-positive DM-ILD). In this retrospective study, a total of 117 anti-MDA5-positive DM-ILD patients were admitted to our hospital. All patients underwent an assessment of autoantibodies, serum ferritin levels, and lung high-resolution CT scans. In patients with anti-MDA5-positive DM-ILD, the incidence of SE/ME was found to be 11.1%, which was significantly higher compared to patients with anti-synthetase syndrome (p<0.01). The mortality rate among anti-MDA5-positive DM-ILD patients with SE/ME was significantly higher than those without SE/ME (p=0.0022). There was no statistically significant difference in the occurrence of SE/ME between patients with positive anti-Ro-52 antibodies and those with negative anti-Ro-52 antibodies (p=0.18). Patients with higher serum ferritin levels (1000 ng/ml ≤serum ferritin ≤1500 ng/ml) had a higher likelihood of developing SE/ME compared to patients with lower serum ferritin levels (serum ferritin <500 ng/ml) (p<0.01). Among 13 anti-MDA5-positive DM-ILD patients with SE/ME, six (46.2%) developed SE/ME within 1 month of being diagnosed and 53.8% of patients underwent positive pressure ventilation prior to the onset of SE/ME. We found that SE/ME is not uncommon in anti-MDA5-positive DM-ILD and is an important factor associated with poor patient prognosis. The occurrence of SE/ME is correlated with high levels of serum ferritin and is not related to anti-Ro-52 antibodies. Rheumatologists should pay close attention to SE/ME caused by positive pressure ventilation in anti-MDA5-positive DM-ILD patients.

Anemia and COVID-19

Objectives: Coronavirus disease-19 (COVID-19) is an infective-inflammatory disease that mainly affects the lungs. Hematological symptoms such as thrombocytopenia, decreased eosinophil and lymphocyte counts are quite common and are of prognostic importance. Although it is known that the presence of anemia generally increases the severity of respiratory diseases, there is little data on the prevalence and importance of anemia in COVID-19. In this study, our aim is to evaluate the clinical features of patients with anemia in COVID-19 infection and to investigate the relationship between the presence of anemia and the prognosis of the disease. Methods: This retrospective, observational study included 353 patients who presented to our pandemic reference hospital between 15.04.2020 and 15.05.2020 and were diagnosed with SARS-CoV-2 infection confirmed by real-time reverse transcription polymerase chain reaction (PCR) test and typical clinical symptoms. Results: Our study included 167 female and 186 male patients. The mean age was 54.54 ± 18.28 years (range 19-99). One hundred forty-eight (41.93%) patients had anemia. In patients with anemia, age was higher than others (p &amp;lt; 0.001). The percentage of women was significantly higher in the anemia group (p &amp;lt; 0.001). Comorbidities were observed more in the anemia group. The percentages of intensive care stay (p = 0.003) and mortality (p = 0.001) were significantly higher in the anemia group compared to the group without anemia. Logistic regression analysis was performed to determine the important risk factors of death. We found patients with high age (p = 0.001), high red cell distribution width-coefficient of variation (RDW-CV) levels (p = 0.009), high D-dimer levels (p = 0.012) and high ferritin levels (p &amp;lt; 0.001) have higher risk of death. Anemia was found to be non-significant. Conclusions: Anemia is frequently observed in patients with severe COVID-19 disease and low hemoglobin values at presentation are thought to be associated with a worse prognosis. Being more sensitive to the hemoglobin levels of COVID-19 patients is important for early recognition of the high-risk patient group and for successful patient management. However, in our study, the presence of anemia was found to be effective in mortality in univariate analysis, but not in multivariate analysis. According to the multivariate analysis of this study, advanced age, high D-dimer, high ferritin and RDW-CV determine death.

Iron metabolism and metabolic dysfunction-associated fatty liver disease

Abstract Objective: The primary objective of this study was to investigate the association between biomarkers of iron metabolism and metabolic dysfunction-associated fatty liver disease in individuals with type 2 diabetes and non-diabetic individuals compared to a control group. We also examined the possible association between estimated liver fibrosis and serum ferritin levels in all three groups. Methods: We conducted a descriptive, cross-sectional, comparative study involving subjects diagnosed with diabetes and/or metabolic dysfunction-associated fatty liver disease from an outpatient diabetology clinic and two general practices in Târgu Mureș. The patient population was divided into 3 groups: first group including diabetic patients suffering from fatty liver disease, second group including patients without fatty liver disease and third group with non-diabetic patients suffering from fatty liver disease. We compared the three groups based on specific laboratory tests. Results: Patients with fatty liver disease had significantly higher ferritin and transferrin saturation levels than non-fatty liver disease sufferers (p&lt;0.05). Transferrin saturation of the first group was significantly (p&lt;0.05) higher compared to the non-diabetic fatty liver disease group. Ferritin correlated well with Fibrosis-4 index level (τ= 0.193, p&lt;0.01) considering the whole sample and especially in the first group. Conclusions: In our study, there was a clear association between higher ferritin levels and the presence of metabolic dysfunction-associated fatty liver disease. The higher transferrin saturation observed in diabetic patients suffering from metabolic dysfunction-associated fatty liver disease may indicate the possible etiological significance of iron overload. Higher ferritin levels in diabetes increase the risk of liver fibrosis.

Hemophagocytic lymphohistiocytosis associated with sodium valproate

Hemophagocytic lymphohistiocytosis(HLH) is known to have numerous causes, such as chronic inflammation, infection, malignancy, drug use, and primary or familial HLH. HLH triggered by valproate (VPA) has rarely been reported in the literature. Here we describe a pediatric patient with HLH induced by VPA. A 5-years-old girl presented to our center with recurrent fever accompanied by diffuse generalized rash after 2 weeks of taking oral VPA. Physical examination revealed hepatosplenomegaly; laboratory findings showed bicytopenia (hemoglobin and platelet), hemophagocytic cells on the bone marrow smear, hypofibrinogenaemia and hypertriglyceridaemia, and a high ferritin level. She was diagnosed to have HLH associated with VPA. She was treated with intravenous immunoglobulin, glucocorticoid and withdrawal of the sodium valproate, and she completely recovered. In conclusion, VPA can trigger HLH, a potentially fatal condition.

Patient Blood Management in Microsurgical Procedures for Reconstructive Surgery.

Introduction: The main purpose of reconstructive surgery (RS) is to restore the integrity of soft tissues damaged by trauma, surgery, congenital deformity, burns, or infection. Microsurgical techniques consist of harvesting tissues that are separated from the vascular sources of the donor site and anastomosed to the vessels of the recipient site. In these procedures, there are some preoperative modifiable factors that have the potential to influence the outcome of the flap transfer and its anastomosis. The management of anemia, which is always present in the postoperative period and plays a decisive role in the implantation of the flap, covers significant importance, and is associated with clinical and laboratory settings of chronic inflammation. Methods: Chronic inflammatory anemia (ACD) is a constant condition in patients who have undergone RS and correlates with the perfusion of the free flap. The aim of this treatment protocol is to reduce the transfusion rate by maintaining both a good organ perfusion and correction of the patient's anemic state. From January 2017 to September 2019, we studied 16 patients (16 males, mean age 38 years) who underwent microsurgical procedures for RS. Their hemoglobin (Hb) levels, corpuscular indexes, transferrin saturation (TSAT) ferritin concentrations and creatinine clearance were measured the first day after surgery (T0), after the first week (T1), and after five weeks (T2). At T0, all the patients showed low hemoglobin levels (average 7.4 g/dL, STD 0.71 range 6.2-7.4 g dL-1), with an MCV of 72, MCH of 28, MCHC of 33, RDW of 16, serum iron of 35, ferritin of 28, Ret% of 1.36, TRF of 277, creatinine clearance of 119 and high ferritin levels (range 320-560 ng mL-1) with TSAT less than 20%. All the patients were assessed for their clinical status, medical history and comorbidities before the beginning of the therapy. Results: A collaboration between the two departments (Department of Transfusion Medicine and Department of Reconstructive Surgery) resulted in the application of a therapeutic protocol with erythropoietic stimulating agents (ESAs) (Binocrit 6000 UI/week) and intravenous iron every other day, starting the second day after surgery. Thirteen patients received ESAs and FCM (ferric carboxymaltose, 500-1000 mg per session), three patients received ESAs and iron gluconate (one vial every other day). No patients received blood transfusions. No side effects were observed, and most importantly, no limb or flap rejection occurred. Conclusions: Preliminary data from our protocol show an optimal therapeutic response, notwithstanding the very limited scientific literature and data available in this specific surgical field. The enrollment of further patients will allow us to validate this therapeutic protocol with statistically sound data.

Serum ferritin level during hospitalization is associated with Brain Fog after COVID-19

The coronavirus disease 2019 (COVID-19) remains an epidemic worldwide. Most patients suffer residual symptoms, the so-called “Long COVID,” which includes respiratory and neuropsychiatric symptoms. Brain Fog, one of the symptoms of Long COVID, is a major public health issue because it can impair patients’ quality of life even after recovery from the disease. However, neither the pathogenesis nor the treatment of this condition remains unknown. We focused on serum ferritin levels in this study and collected information on the onset of Brain Fog through questionnaires and found that high ferritin levels during hospitalization were associated with the occurrence of Brain Fog. In addition, we excluded confounders as far as possible using propensity score analyses and found that ferritin was independently associated with Brain Fog in most of the models. We conducted phase analysis and evaluated the interaction of each phase with ferritin levels and Brain Fog. We found a positive correlation between serum ferritin levels during hospitalization and Brain Fog after COVID-19. High ferritin levels in patients with Brain Fog may reflect the contribution of chronic inflammation in the development of Brain Fog. This study provides a novel insight into the pathogenic mechanism of Brain Fog after COVID-19.

Systemic inflammatory indices for predicting prognosis of myelofibrosis

The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 × 109/L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.

Predictive value of ferritin, glucose, urea, and creatinine for COVID-19 severity and mortality in patients from Asir, Saudi Arabia.

To correlate demographics, blood groupings, and laboratory characteristics of hospitalized COVID-19 patients with disease severity and outcomes. This study included 294 COVID-19 patients. Data on patient age, gender, laboratory results, clinical severity, mortality, comorbidities, and blood group were obtained from medical records retrospectively. High levels of ferritin (p<0.01), urea (p<0.0001), and creatinine (p<0.05) were detected in intensive care unit (ICU)-admitted patients. Ferritin (p<0.05), glucose (p<0.0001), urea (p<0.0001), and creatinine (p<0.0001) were significantly higher in non-survivor compared to survivor COVID-19 patients. Predictors for ICU admission among patients were ferritin (odd ratio [OR]=0.999, p=0.0055) and urea (OR=0.991, p=0.0001). Predictors for mortality were: age (OR=0.963, p=0.0001), ferritin (OR=0.999, p=0.0149), glucose (OR=0.993, p=0.0001), urea (OR=0.976, p=0.0001), and creatinine (OR=0.556, p=0.0001). The most reliable laboratory parameters in predicting mortality were: age (area under the curve [AUC]=0.685, p<0.0001), ferritin (AUC=0.610, p<0.05), glucose (AUC=0.681, p<0.0001), urea (AUC=0.856, p<0.0001), and creatinine (AUC=0.823, p<0.0001). High ferritin, glucose, urea, and creatinine levels may predict poor outcomes in COVID-19 patients. These findings could help predict admissions to the ICU and mortality among such patients.

End-stage kidney disease patients with severe coronavirus disease: clinical characteristics, biological data, and mortality in nephrology unit, short communication.

A retrospective study was conducted in the Nephrology unit between October 2020 and February 2022. Were included all adult patients who presented ESKD on dialysis, or not on dialysis with an estimated glomerular filtration rate less than or equal to 15ml/min/1.73m2 and presenting a confirmed COVID-19. Patients with ESKD who were immediately admitted to the ICU were excluded. Sixty-five patients' data were collected. The mean age was 58.9 ±16.7 years and 60% were males. Hypertension arterial and diabetes observed in 75% and 56.3% of cases, respectively. 52.3% were on haemodialysis, 4.6% were on peritoneal dialysis and 43.1% not were on dialysis. 94% of the patients were symptomatic of COVID-19, dominated by dyspnoea (87.5%), cough (65.6%), and fever (58.5%). More than half of patients (58.5%) showed signs of gravity and 62% required oxygen therapy. According to thoracic scan, 72.3% were classified COVID-19 Raw Data System 5 and 6. Most patients had severe anaemia (58.5%), lymphopenia (81.3%), and high levels of C-reactive protein (54%), D-Dimer (93.6%) and ferritin (91.2%). 38.5% of patients presented complications of whom 60% were transferred to ICU. Mortality was observed in 8% of cases. Rigorous monitoring is necessary for patients in ESKD, particularly those with comorbidities, to reduce the risk of severe form of COVID-19.

Independent risk factors for COVID-19-associated coagulopathy.

Past three years since the beginning of the outbreak, we have obtained satisfactory data on COVID-19. However, data on risk factors of COVID-19-associated coagulopathy (CAC) are extremely limited. Prediction of CAC might be a game changer since it is related to poor prognosis. Seeking independent risk factors for CAC was the main aim of the study. 510 hospitalized COVID-19 patients were retrospectively screened. Forty-eight of them were excluded due to irrelevant D-dimer or ferritin elevation. The remaining patients were stratified into three groups as overt coagulopathy, significant pulmonary microthrombosis, and patients without coagulopathy. The overt coagulopathy group included cases with macrothrombosis or disseminated intravascular coagulation (DIC). The significant pulmonary microthrombosis group covered the cases that had clinical deterioration with simultaneous marked D-dimer elevation. The group of patients without coagulopathy included the asymptomatic patients with normal or elevated D-dimer levels. Overt coagulopathy developed in 3.2% and significant pulmonary microthrombosis in 10.1% of the patients. In the multivariate analysis, not receiving low molecular weight heparin (LMWH) (p=0.002), a level of D-dimer >15,000 U/ml (p=0.013) were associated with overt coagulopathy. In addition, levels of initial LDH >480 IU/L (p=0.022) and initial ferritin >1,000 ng/ml (p=0.036) were associated with significant pulmonary microthrombosis. Not receiving LMWH (p=0.001) was also associated with significant pulmonary microthrombosis, when multivariate analysis was performed by the parameters with a p-value <0.1 in the univariate analysis. Furthermore, all cases with DIC had Gram-negative bacterial sepsis. Not receiving LMWH, high levels of D-dimer, initial LDH, and initial ferritin are independent risk factors for CAC. DIC does not appear to develop based on COVID-19.

Cytokine Storm score (CSs) in COVID-19 Patients Smokers at Dr. Saiful Anwar Malang

Background: After 3 years of the COVID-19 pandemic, its escalation is still causing a critical global health problem. Cytokine storm is a severe complication of COVID-19, and smoking is a risk factor for death. The prevalence of smoking in Indonesia is very high, but there is still little research on the effect of smoking on the occurrence of cytokine storms. The Cytokines Storm Score (CSs) is a quick and simple method for detecting cytokine storms early by utilizing D-dimer, lactate dehydrogenase (LDH), ferritin, and C-reactive protein (CRP) parameters. Objective: To evaluate CSs in COVID-19 patients smokers Methods: Retrospective analysis of 120 confirmed COVID-19 patients in November 2020–2021, divided into 2 groups (60 smokers and nonsmokers), male, without comorbidities. analysis using Chi-square and Mann-Whitney. Prior to the CSs examination, lymphopenia is required. CSs were positive if at least two of the D-dimer, LDH, or ferritin levels were elevated. The CRP level is measured if there is an increase in only one of these values. Elevated CRP, lymphopenia, and impaired D-Dimer, LDH, or ferritin will result in positive CSs. Results: CSs were significantly higher in smokers than non-smokers (54.5% vs. 45.5%, p = 0.024). D-dimer and CRP levels were significantly higher in smokers than non-smokers (1620 ng/mL vs. 1002.5 ng/mL, p = 0.001; and 13.8 mg/dL vs. 7.75 mg/dL, p = 0.001). Lower LDH and higher ferritin levels were not significant in smokers compared to nonsmokers (405.5 IU/L vs. 418 IU/L, p = 0.160; and 886.65 ng/mL vs. 790.5 ng/mL, p = 0.203). Conclusion: Cytokines Storm scores (CSs) increased significantly in COVID-19 patients who smoked, D-dimer and CRP levels were significantly higher in smoking COVID-19 patients compared to non-smokers

Serum Ferritin Level as a Predictor of Disease Severity in Patients with Dengue Infection

Background: Dengue infection is a major public health threat. The clinical spectrum of dengue infection is variable from mild fever to severe forms. Early laboratory diagnosis of dengue fever is important to provide appropriate treatment to the patients and to prevent potential complications. Although there are various biomarkers to predict the severity of dengue, they are not routinely used in clinical practice for prognostication. This study evaluated the performance of serum ferritin to predict the severity of dengue at an earlier stage as it is an inexpensive and easily accessible biomarker. Methods: Total 62 patients with diagnosis of dengue fever were enrolled after final selection. Serum ferritin levels of all the patients were measured on the day of admission. Patients were then divided into two groups on the basis of ferritin level. Group A comprising those with normal level and those having raised level were included in group B. Patients were then regularly followed up both clinically and biochemically during their hospital stay to see disease progression. Discharge from the hospital without complications or death of the patient during the hospital stay was the end point of the study. Every patient was managed according to the National Guideline for Clinical Management of Dengue Syndrome. Results: Most of the respondents (58.1%) belonged to the age group of 18-30 years with male predominance (69.4%). A significant association was found between the BMI of respondents &amp; the groups (p&lt;0.05). Highly significant association was reported among mucosal bleed (37.1%), clinical fluid accumulation (29.0%) &amp; liver enlargement (30.6%) with ferritin level (p&lt;0.001). A positive correlation was found between serum ferritin &amp; hematocrit level of the respondents (r=0.719; p&lt;0.001) and a negative correlation was found between serum ferritin &amp; platelet level of the respondents (r= -0.857; p&lt;0.001), both of which were highly significant. Patients with high level of ferritin .

Attenuation of ferroptosis as a potential therapeutic target for neuropsychiatric manifestations of post-COVID syndrome.

Coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), is associated with the persistence of pre-existing or the emergence of new neurological and psychiatric manifestations as a part of a multi-system affection known collectively as "post-COVID syndrome." Cognitive decline is the most prominent feature among these manifestations. The underlying neurobiological mechanisms remain under intense investigation. Ferroptosis is a form of cell death that results from the excessive accumulation of intracellular reactive iron, which mediates lipid peroxidation. The accumulation of lipid-based reactive oxygen species (ROS) and the impairment of glutathione peroxidase 4 (GPX4) activity trigger ferroptosis. The COVID-19-associated cytokine storm enhances the levels of circulating pro-inflammatory cytokines and causes immune-cell hyper-activation that is tightly linked to iron dysregulation. Severe COVID-19 presents with iron overload as one of the main features of its pathogenesis. Iron overload promotes a state of inflammation and immune dysfunction. This is well demonstrated by the strong association between COVID-19 severity and high levels of ferritin, which is a well-known inflammatory and iron overload biomarker. The dysregulation of iron, the high levels of lipid peroxidation biomarkers, and the inactivation of GPX4 in COVID-19 patients make a strong case for ferroptosis as a potential mechanism behind post-COVID neuropsychiatric deficits. Therefore, here we review the characteristics of iron and the attenuation of ferroptosis as a potential therapeutic target for neuropsychiatric post-COVID syndrome.