Hyperferritinemia In Patients Research Articles

Factors associated with pre-treatment hyperferritinemia in patients with chronic hepatitis C virus infection

Pre-treatment host and viral factors may affect serum ferritin levels in patients with hepatitis C virus (HCV) infection. We delineated pre-treatment factors associated with hyperferritinemia in these patients. 1682 eligible patients underwent pre-treatment assessment for serum ferritin and various host/viral factors. Univariate and multivariate logistic regression analyses were conducted to evaluate factors associated with hyperferritinemia. Multivariate logistic regression analyses revealed that age > 50 years (adjusted odds ratio [OR]: 1.38 (95% confidence interval [CI] 1.09–1.74), p = 0.008), fibrosis stage ≥ F3 (adjusted OR: 1.36 (95% CI 1.04–1.77), p = 0.02), fibrosis index based on four parameters (FIB-4) > 3.25 (adjusted OR: 1.46 (95% CI 1.11–1.92), p = 0.01), presence of metabolic dysfunction-associated steatotic liver disease (MASLD) (adjusted OR: 1.43 (95% CI 1.21–1.76), p = 0.001), and alanine transaminase (ALT) > 2 folds upper limit of normal (ULN) (adjusted OR: 2.87 (95% CI 2.20–3.75), p < 0.001) were associated hyperferritinemia. The log10 value of HBV or HCV viral load was not associated with the log10 value of ferritin level (Spearman’s rank correlation coefficient: − 0.025, p = 0.81 and 0.002, p = 0.92). In conclusion, host factors, rather than viral factors, are associated with hyperferritinemia in patients with HCV.

Lactoferrin efficacy in treating hyperferritinemia in patients suffering from pathologies unrelated to hereditary hemochromatosis.

Ferritin (Ftn), a globular protein, sequesters 4500 atoms of iron per molecule. Elevated serum Ftn levels (hyperferritinemia) is an indicator of iron homeostasis disorders. We present the results of an observational study involving 17 patients with hyperferritinemia unrelated to hereditary hemochromatosis (HH). All participants received treatment with 200mg of bovine lactoferrin (bLf) once (n=14) or twice (n=3) a day before meals. The patients, treated with 200mg/day of bLf, exhibited a significant increase in red blood cells (+10%, p<0.001), hemoglobin (+4%, p<0.001), and hematocrit (+15%, p=0.004), accompanied by a significant reduction in serum Ftn levels (-52%, p<0.001), C-reactive protein (CRP) (-85.0%, p<0.001), and D-dimers (-19%, p<0.001). Among the three patients treated with 400mg/day of bLf, two had effects similar to those of patients bLf-treated with 200mg/day and one experienced a strong reduction of Ftn, CRP, and erythrocyte sedimentation rate (from -97% to -75%). The decrease in serum Ftn levels due to bLf treatment was largely independent of gender (p=0.78), age (p=0.66), baseline symptoms (p=0.20), and concomitant acute (p=0.34) and chronic (p=0.53) infections. Although this observational pilot study yields positive effects in patients with hyperferritinemia unrelated to HH treated with bLf, a larger sample size is needed for conclusive results.

The Relationship between the Laboratory Biomarkers of SARS-CoV-2 Patients with Type 2 Diabetes at Discharge and the Severity of the Viral Pathology.

In this study, we evaluated the discharge status of patients with type 2 diabetes mellitus and SARS-CoV-2 infection, focusing on the inflammatory profile through biomarkers such as procalcitonin, CRP, LDH, fibrinogen, ESR, and ferritin, as well as electrolyte levels and the prior diagnosis of diabetes or its identification at the time of hospitalization. We assessed parameters at discharge for 45 patients admitted to the Clinical Hospital "Gavril Curteanu" Oradea between 21 October 2021, and 31 December 2021, randomly selected, having as the main inclusion criteria the positive RT-PCR rapid antigen test for viral infection and the diagnosis of type 2 diabetes. At discharge, patients with type 2 diabetes registered significantly lower mean procalcitonin levels among those who survived compared to those who died from COVID-19. In our study, ferritin and hemoglobin values in individuals with type 2 diabetes were outside the reference range at discharge and correlated with severe or moderate forms of COVID-19 infection. Additionally, elevated ferritin levels at discharge were statistically associated with hypokalemia and elevated levels of ESR at discharge. Another strong statistically significant correlation was identified between high CRP levels at discharge, strongly associated (p < 0.001) with elevated LDH and fibrinogen levels in patients with type 2 diabetes and SARS-CoV-2 viral infection. The increase in CRP was inversely statistically associated with the tendency of serum potassium to decrease at discharge in patients with type 2 diabetes and COVID-19. Identifying type 2 diabetes metabolic pathology at the time of hospitalization for SARS-CoV-2 infection, compared to pre-infection diabetes diagnosis, did not significantly influence the laboratory parameter status at the time of discharge. At the discharge of patients with type 2 diabetes and viral infection with the novel coronavirus, procalcitonin was significantly reduced in those who survived COVID-19 infection, and disease severity was significantly correlated with hyperferritinemia and decreased hemoglobin at discharge. Hyperferritinemia in patients with type 2 diabetes and COVID-19 at discharge was associated with hypokalemia and persistent inflammation (quantified by ESR at discharge). The low number of erythrocytes at discharge is associated with maintaining inflammation at discharge (quantified by the ESR value).

The association between triglyceride-glucose index and hyperferritinemia in patients with type 2 diabetes mellitus.

To investigate the relationship between the triglyceride-glucose (TyG) index and serum ferritin (SF) levels in patients with type 2 diabetes mellitus (T2DM). A total of 881 T2DM patients were divided into T1(TyG index < 1.66), T2 (1.66 ≤ TyG index < 2.21), and T3 (TyG index ≥ 2.21) groups according to the tertiles of the TyG index. The differences in SF levels and the prevalence of hyperferritinemia (SF ≥ 300ng/mL for male or SF ≥ 150ng/mL for female) were compared. The independent correlations between the TyG index and SF, and between hyperferritinemia and TyG in T2DM patients were analyzed, respectively. SF levels in male T2DM patients were higher in the T3 group (250.12ng/mL) than in the T1 and T2 groups (180.45 and 196.56ng/mL, both p < 0.01),while in female patients with T2DM,SF levels were higher in the T3 group (157.25ng/mL) than in the T1 group (111.06ng/mL, p < 0.05).The prevalence of hyperferritinemia in male T2DM patients was higher in the T3 group (31.3%) than those in the T1 and T2 groups (10.4% and 17.3%, both p < 0.05).The TyG index was positively correlated with SF levels in T2DM patients (R = 0.178, p < 0.001).TyG index was independently and positively correlated with SF levels after adjusting for confounders (β = 0.097, 95%CI [2.870,38.148], p = 0.023).The TyG index was positively independently correlated with hyperferritinemia in male T2DM patients (OR = 1.651, 95%CI [1.120,2.432], p = 0.011). In parallel with increasing TyG index SF levels gradually increased. The TyG index was positively correlated with SF levels in patients with T2DM and was positively correlated with hyperferritinemia in male T2DM patients.

The Decisive Role of Pronounced Hyperferritinemia for Diagnosis and Prognosis in the Spectrum of Hematological Disorders

Background Ferritin is an iron storage protein that can also be elevated in serum by various inflammatory pathologic states. Hyperferritinemia is defined as ferritin levels ≥500 ng/mL and is mainly related to hemophagocytic lymphohistiocytosis (HLH) when seen in association with hematologic abnormalities. However, its prevalence in the general population has been reported as high as 13%, and its diagnostic and prognostic role has not been determined among the different hematologic disease subgroups, nor for different levels besides extreme hyperferritinemia (ferritin levels ≥10,000 ng/mL). Our aim was to describe the hematologic etiologies for hyperferritinemia and define the impact over diagnosis and clinical outcomes of different ferritin values within the 500 ng/mL and 15,000 ng/mL range. Methods This was a retrospective single-center study that included all consecutive cases of hyperferritinemia according to our laboratory records between January 2015 and December 2019. A total of 6602 cases were identified. After excluding cases with incomplete medical records or redundant ferritin measurements, more than one measurement within six months, 3193 cases were included. Chi-squared test and Kruskal-Wallis ANOVA tests were performed to demonstrate differences between categorical and quantitative variables, respectively. ROC curves were used to analyze the diagnostic performance of our tests. Survival analyses were carried out with Kaplan-Meier curves. All statistical analyses were carried out by IBM SPSS version 26. Results After non-HIV infection (26.1%; n=832), hematologic disease was the second most common etiology at 23.5% (n=749) within the cohort. The median age for this group was 50 years (17-95), and the median ferritin level was 1,133.3 ng/mL (500-15,000). Hematologic diagnoses were grouped into four categories: hematologic malignancy (60%), iron overload (26%), hemolytic anemia (7%), and HLH (7%). Median serum ferritin was higher in patients with HLH (6,717.5 ng/mL) when compared to other subgroups (p<0.01). Additional baseline characteristics are shown in Table 1. With a cut-off of >3,000 ng/ml (pronounced hyperferritinemia), ferritin level as a diagnostic test for HLH had a sensitivity of 75%, specificity of 87.8%, an area under the curve (AUC) of 0.814, positive predictive value (PPV) of 31.5%, and negative predictive value (NPV) of 97.9%. The same cutoff value in all 3,193 episodes of hyperferritinemia had similar results (sensitivity of 75%, specificity of 92.5%, AUC of 0.837, PPV of 14.1%, NPV of 99.6%). There was no association between pronounced hyperferritinemia and hematologic malignancy, iron overload, or hemolytic anemia. Overall survival (OS) at six months was 79.6% (n=596). When stratified per hematologic diagnosis, OS was 55.8% (n=29) for HLH, 76.4% (n=344) for hematologic malignancy, 89.8% (n=176) for iron overload, and 92.2% (n=47) for hemolytic anemia (p<0.01). On univariate analysis, pronounced hyperferritinemia was related to an increased mortality in patients with hematologic malignancy (p<0.01) and iron overload (p<0.01). There was no association between pronounced hyperferritinemia and mortality for HLH or hemolytic anemia (Figure 1). Conclusion To our knowledge, this is the first study to analyze the impact of hyperferritinemia in patients with diverse hematologic diagnoses. Our findings suggest that a cut-off value of >3000 ng/mL has a high NPV to exclude the diagnosis of HLH, within other differential diagnoses. Regarding prognosis, besides HLH, where clinical outcomes are known to be poor, pronounced hyperferritinemia can be useful in identifying patients with a higher risk of early mortality within the hematologic malignancy and iron overload subgroups. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

S1419 The Relationship Between Clinical Factors and High Ferritin in Metabolic Surgery Patients With Hepatic Iron Overload

Introduction: Increased serum ferritin is a commonly used blood test that reflects iron stores including liver iron overload. However, the interpretation of ferritin levels is influenced both by iron stores and inflammation. In patients with obesity, ferritin levels may be elevated with iron overload and with inflammation. This study investigated the clinical factors associated with hyperferritinemia in patients with severe obesity and hepatic iron overload. Methods: This study included 4359 patients that had a wedge liver biopsy and documented pre-operative serum ferritin at time of primary metabolic surgery between 2004 and 2021. The standard Perls’/Prussian Blue iron stain was used to diagnose hepatic iron overload. Patients with iron deficiency (ferritin< 30 ng/ml) and extremely high ferritin levels (ferritin >1000 ng/ml) were excluded. Elevated ferritin was defined as 300-999 ng/ml in males and 200-999 ng/ml in females. Clinical data collected on each patient included sex, age, BMI, race/ethnicity, smoking, transferrin saturation, diabetes, hypertension, hyperlipidemia, liver steatosis, liver fibrosis, and type of cells involved in liver iron overload. Multiple logistic regression was used to determine which clinical factors were independently associated with elevated ferritin. Results: The 4351 metabolic surgery patients included 703 (16%) with hepatic iron overload. These 703 patients included 441 (63%) females with a mean age of 47.8 years (SD=10.6), mean BMI of 47.1 kg/m2 (SD=8.1), and 37% (n=258) with elevated ferritin. The types of cells involved with the liver iron overload included Kupffer (34%), hepatocyte (37%), and both (29%) but cell type was not associated with elevated ferritin (p=0.317). Factors that were independently related to high ferritin included increasing levels of steatosis, increasing level of fibrosis, presence of hypertension, normal transferrin saturation (≥20%), male sex, and age 40-59 years (see Table). Conclusion: The histopathological and demographic parameters significantly associated with hyperferritinemia in metabolic surgery patients with hepatic iron overload suggest the role of ferritin in clinical evaluation. The results support the potential association of chronic low-grade systemic inflammation with steatosis, fibrosis, and hypertension when differentiating between hyperferritinemia and normal ferritin levels in patients with severe obesity and excess hepatic iron. Table 1. - Multiple logistic regression for elevated ferritin (versus normal ferritin) within metabolic surgery patients with hepatic parenchymal overload OR 95% CI p-value Steatosis < 5% Reference 5-33% 1.63 [0.98, 2.69] 0.059 34-66% 2.69 [1.44, 5.03] 0.0019 67%+ 6.66 [2.43, 18.24] 0.0002 Fibrosis Grade 0 Reference Grade 1 1.62 [1.06, 2.46] 0.025 Grade 2 2.58 [1.38, 4.81] 0.0029 Hypertension [1.21, 2.45] 0.0024 Yes 1.72 No Reference Transferrin Saturation < 0.0001 ≥20% 2.67 [1.64, 4.35] < 20% Reference Sex [1.08, 2.16] 0.016 Male 1.53 Female Reference Age < 40 Reference 40-59 1.79 [1.17, 2.75] 0.0075 60+ 1.35 [0.74, 2.48] 0.328

THE RELATIONSHIP BETWEEN FERRITIN LEVEL AND THROMBOSIS IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA

Cancer is a well-known condition associated with its treatment and follow-up and increases the risk of thrombosis. As with solid tumors, the risk of venous thromboembolism (VTE) is quite high in lymphomas, especially high-grade B-cell lymphomas. Diffuse large B-cell lymphoma (DLBCL) patients are the most important part of this group. The aim of our study is to determine the effect of ferritin level at the time of diagnosis on thrombosis in DLBCL patients. In this retrospective study, 133 patients who applied to SBU Dışkapı Yıldırım Beyazıt Training and Research Hospital Hematology clinic and were diagnosed with DLBCL were included in this retrospective study. Demographic characteristics, disease-related findings, presence of central venous catheter and laboratory results of the patients were recorded. The median age of the patients included in the study was 63.13±14.85 years. There were 67 female and 66 male patients, stage 1-2: 54 patients, stage 3-4: 79 patients at the time of diagnosis. Thrombosis was observed in 16 of the patients. Median ferritin levels were 357.42 ug/L and 253.07 ug/L, respectively, between the group with and without thrombosis (p:0.026). The ferritin value, which was examined for the presence of thrombosis, was determined as 227 ug/L as a result of the ROC analysis. In the logistic regression analysis, the risk of developing thrombosis was 6.1 times higher in those with a ferritin level ≥227 ug/L. Hyperferritinemia may be an independent risk factor for the development of thrombosis in DLBCL patients. In case of hyperferritinemia in patients, initiation of thromboprophylaxis may be an appropriate approach.

Association of Hyperferritinemia With Distinct Host Response Aberrations in Patients With Community-Acquired Pneumonia.

BackgroundStrongly elevated ferritin levels have been proposed to reflect systemic hyperinflammation in patients admitted to the intensive care unit. Knowledge of the incidence and pathophysiological implications of hyperferritinemia in patients with acute infection admitted to a non–intensive care setting is limited.MethodsWe determined the association between hyperferritinemia, defined by 2 cutoff values (500 and 250 ng/mL), and aberrations in key host response mechanisms among patients with community-acquired pneumonia (CAP) on admission to a general hospital ward (clinicaltrials.gov NCT02928367; trialregister.nl NTR6163).ResultsPlasma ferritin levels were higher in patients with CAP (n = 174; median [interquartile ranges], 259.5 [123.1–518.3] ng/mL) than in age- and sex-matched controls without infection (n = 50; 102.8 [53.5–185.7] ng/mL); P < .001); they were ≥500 ng/mL in 46 patients (26%) and ≥250 ng/mL in 90 (52%). Measurements of 26 biomarkers reflective of distinct pathophysiological domains showed that hyperferritinemia was associated with enhanced systemic inflammation, neutrophil activation, cytokine release, endothelial cell activation and dysfunction, and activation of the coagulation system. Results were robust across different cutoff values.ConclusionsHyperferritinemia identifies patients with CAP with a broad deregulation of various host response mechanisms implicated in the pathogenesis of sepsis. This could inform future therapeutic strategies targeting subgroups within the CAP population.

Anti‐ribosomal P protein antibodies in patients with systemic lupus erythematosus is associated with hyperferritinemia

Anti-ribosomal P protein antibodies (anti-ribo P) have been reported as one of the specific autoantibodies in patients with systemic lupus erythematosus (SLE) and has been demonstrated to bind and activate macrophages in vitro. Clinically, hyperferritinemia has been known to be a biomarker for macrophage activation. The aim of this study is to clarify the relationship of anti-ribo P and clinical characteristics and biomarkers including serum ferritin in patients with SLE. Clinical parameters and laboratory data were measured in patients with active SLE (N=127) in our university hospital. The risk factors affected by anti-ribo P were retrospectively calculated by logistic regression analysis, and the correlation of anti-ribo P and clinical factors was demonstrated. Anti-ribo P was significantly elevated in active SLE compared to non-SLE diseases (P<.0001). Sensitivity and the specificity of anti-ribo P in patients with SLE were 32.0% and 99.3%, respectively. Patients positive for anti-ribo P had the highest risk for elevated serum ferritin (odds ratio: 8.432). Accordingly, anti-ribo P positive patients had significantly elevated serum ferritin compared to negative patients (P=.024). A significant positive correlation was observed between the anti-ribo P titer and the serum ferritin level (r2 =.07, t=5.22, P=.0081), but not serum interleukin (IL)-6 in SLE patients. The presence of anti-ribo P is a risk factor for higher ferritin levels that is independent of systemic inflammation regulated by IL-6. We speculate that anti-ribo P could be directly associated with macrophage activation leading to hyperferritinemia in patients with SLE.

Long-Term Prognosis of Hyperferritinemia Induced by Intravenous Iron Therapy in Patients Undergoing Maintenance Hemodialysis: A 10-Year, Single-Center Study.

Optimal ferritin level in hemodialysis patients between Japan and other countries is controversial. Long-term side effects of iron supplementation in these patients remain unclear. We aimed to elucidate whether past hyperferritinemia in hemodialysis patients was associated with high risk of death and cerebrovascular and cardiovascular diseases (CCVDs). This small retrospective cohort study included approximately 44 patients unintentionally supplemented with excessive intravenous iron. A significantly higher risk of CCVDs was observed in patients with initial serum ferritin levels ≥1000 ng/mL than in the remaining patients. High ferritin levels slowly decreased to <300 ng/mL in a median of 24.2 (10.5–46.5) months without treatment. However, compared with the remaining patients, only patients whose ferritin levels did not decrease to <300 ng/mL steadily had a significantly higher risk of all-cause death (hazard ratio, 9.6). Long-term hyperferritinemia due to intravenous iron therapy is a risk factor for death in maintenance hemodialysis patients. For a prolonged better prognosis, intravenous iron should be carefully administered so as to avoid hyperferritinemia in patients with hemodialysis.

Hyperferritinemia in patients with COVID-19: An opportunity for iron chelation?

Studies from China on COVID-19 revealed that nonsurvivors had cytokine storm with high IL-6 and hyperferritinemia. Iron liberated from necrotic cells may catalyze free radical production and amplify lipid peroxidation causing membrane dysfunction and multiorgan failure. Consequently, iron chelators have been successfully utilized in various experimental and clinical models of cytokine storm and multiorgan damage, such as in ischemia-reperfusion injury, sepsis, and infections. Since viral replication may be influenced by iron accumulation, iron chelation has been proven beneficial in a variety of viral infections, such as HIV-1, hepatitis B virus, Mengovirus, Marburg hemorrhagic fever, Enterovirus 71, and West Nile virus. In this commentary, we elaborate on the idea of considering iron chelation as a therapeutic modality in patients with severe COVID-19 infection. For critically ill patients in the ICU, intravenous deferoxamine would provide sufficient and rapid iron chelation to ameliorate cytokine storm, whereas in less severe cases an oral chelatorcould prevent the development of excessive inflammatory response.

Association of Metabolic Syndrome and Hyperferritinemia in Patients at Cardiovascular Risk.

AimTo evaluate the association between parameters of hyperferritinemia (HF) and metabolic syndrome (MS) in patients at cardiovascular risk.Patients and MethodsThis is a cross-sectional analytical observational study that included 269 patients who attended a cardiology unit. Biochemical and anthropometric parameters were evaluated to identify the presence of HF and MS. The presence of MS was evaluated according to NCEP ATP III. Biochemical parameters (glycemia, triglycerides, HDL-c) were assessed according to the manufacturer’s protocols. Anthropometric measurements and blood pressure measurements were made by a trained professional. The chi-square (X2) test, odds ratio, normality distribution (verified by the Kolmogorov–Smirnov test), and Levene’s test were used to analyze the variables. To evaluate the effect of MS, HF, and the interaction between MS and HF, two-way analysis of variance (ANOVA) was performed based on the homogeneity of the variances, followed by Bonferroni’s post hoc comparisons. Spearman correlation analysis was performed to evaluate the relationship between quantitative variables. A multiple linear regression model was used to analyze the effect of covariables. A logistic regression model was built to analyze the variables that contribute significantly to predict the outcome (HF) using the backward method.ResultsOur results showed that 57% of men and 49.5% of women presented with MS; 44% of men and 11% of women presented with HF. The presence of MS and hypertriglyceridemia increase the probability of having HF by up to 2.1 and 1.88 times, respectively, while for male sex it is increased by 6.2 times. Patients with HF have higher values of C-reactive protein, ferritin, and transferrin saturation, regardless of the presence of MS. The linear regression analysis model indicated that the variables considered in this study explain less than 30% of the variation in ferritin and that the presence of MS in men is responsible for 22% of the variation in the probability of the occurrence of HF.ConclusionOur results show that hyperferritinemia is closely associated with the components of MS (positive correlation with glycemia, triglycerides levels, blood pressure, and waist circumference, and negative correlation with HDL-c values) in the studied population.

The effectiveness and safety of a polypeptide drug (Laennec) for the treatment of COVID-19

Hyperferritinemia in patients with COVID-19 is associated with liver dysfunction and an increased risk of the “cytokine storm”. The polypeptide preparation Laennec (6 ml per 350 ml of 0.9% NaCl solution, iv, cap. The first 3 days, from 4 days — 6 ml per 250 ml of 0.9% NaCl solution) was used in 14 patients (age 39–86 years old, 6 men, 8 women) with a long, stagnant course of COVID-19 as a hepatoprotector and immunomodulator as part of complex therapy until a stable remission is achieved. Patients in the control group (n = 14) received only standard therapy. The use of Laennec led to positive clinical dynamics: a decrease in ferritin levels (in men by –282 mcg / l, in women by –80 mcg / l, P = 0.039), an increase in blood oxygenation to the normal range (P = 0.0029), and a decrease in the area of damage lung according to CT data (on average, —10%, P = 0.0027), an increase in the relative content of lymphocytes (+ 8%, P = 0.04), normalization of markers of liver dysfunction (AST, ALT), creatinine and systolic blood pressure (P &lt;0.05). All patients treated with Laennec recovered within 3–15 days after the start of the drug and were discharged with a negative test for the SARS-CoV-2 virus.

Hyperferritinemia in patients with nonalcoholic fatty liver disease.

In liver diseases, hyperferritinemia (HYF) is related to injured cells in acquired and genetic conditions with or without iron overload. It is frequent in patients with nonalcoholic fatty liver disease (NAFLD), in which it is necessary to define the mean of HYF to establish the better approach for them. The present study evaluated the significance of elevated ferritin in patients with NAFLD and steatohepatitis (NASH). The review was performed using search instruments of indexed scientific material, including MEDLINE (by PubMed), Web of Science, IBECS and LILACS, to identify articles published in Portuguese, English and Spanish, from 2005 to May, 2016. Studies eligible included place and year of publication, diagnose criteria to NAFLD, specifications of serum ferritin measurements and/or liver histopathologic study. Exclusion criteria included studies with patients with alcohol consumption ≥ 20 g/day and other liver diseases. A total of 11 from 30 articles were selected. It included 3,564 patients and they were cross-sectional, retrospective, case series and case-control. The result's analyses showed in 10 of these studies a relationship between ferritin elevated serum levels and NAFLD/NASH with and without fibrosis and insulin resistance. Hyperferritinemia in patients with NAFLD/NASH is associated more frequently with hepatocellular injury than hemochromatosis. These data suggest the relevance to evaluate carefully HYF in patients with NAFLD/NASH to establish appropriate clinical approach.

Body iron, serum ferritin, and nonalcoholic fatty liver disease

Body iron, serum ferritin, and nonalcoholic fatty liver disease