Serum Iron Indices Research Articles

Association of Serum Iron Indices with Insulin Resistance Index in Euglycaemic Offspring’s of Diabetic and Non Diabetic Parents: A Case-control Study

Introduction: Altered iron metabolism may be a risk factor for various diseases. There are studies showing that altered iron metabolism is frequently found in type 2 diabetes mellitus patients, but there is lacunae of literature in offspring’s of diabetic parents. Aim: To compare serum iron indices in euglycaemic offsprings of diabetic and non diabetic parents and also to correlate serum iron indices with HOMA-IR. Materials and Methods: This was a case-control study conducted in RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from February 2019 to January 2020. Total 80 euglycaemic healthy individuals were recruited. Out of 80 subjects 40 were cases and 40 were controls. Offspring of non diabetic parents as control group and offspring of diabetic parents as a case group were included in the study. Anthropometric measurements like weight, height was measured and Body Mass Index (BMI) was calculated. Laboratory parameters like complete haemogram, Fasting Blood Sugar (FBS), serum iron markers like serum iron, serum ferritin, serum Total Iron Binding Capacity (TIBC), serum insulin and high sensitive C-reactive protein were analysed and compared between cases and controls. Homeostasis Model Assessment-estimated Insulin Resistance (HOMA-IR) was calculated. Results: Mean age of cases was 34.65±3.06 years and controls was 35.75±3.43 years respectively. Out of total 24 were females and 56 were males. Serum iron markers like serum iron and serum ferritin was significantly increased and serum TIBC was significantly decreased among euglycaemic offspring’s of diabetic parents compared to offspring’s of non diabetic parents. Serum ferritin (r-value=0.389,p-value=0.007) and serum iron (r-value=0.483,p-value=0.001), showed positive correlation with HOMA-IR among euglycaemic offspring’s of diabetic parents. On multiple regression analysis, in model 1 (HOMAIR as dependent variable and serum ferritin, serum iron and serum TIBC as independent variable) serum iron emerged as a significant predictor of insulin resistance, whereas after adding confounding variables like BMI, high-sensitivity C-Reactive Protein (hsCRP), lipid profile with serum iron markers in model 2, serum iron emerged as independent predictor of insulin resistance though regression equations was not statistically significant. Conclusion: Offsprings of diabetic parents showed iron overload and insulin resistance which predisposes them to develop T2DM and serum iron can be used as one of the marker of insulin resistance among offspring of diabetic parents along with other parameters.

Serum iron is negatively correlated with the HbA1c level in children and adolescents with type 1 diabetes mellitus

Although mainly affected by the blood glucose levels, the level of HbA1c could be influenced by other important factors, such as an iron deficiency, which is commonly found in children with type 1 diabetes mellitus (T1DM). However, a clinical judgment could not be established, as previous studies still reported conflicting results and lack of data regarding Indonesia. We aimed to evaluate the correlation between the serum iron and HbA1c levels in children with T1DM. This single-center cross-sectional study was conducted from February to October 2020 at Sanglah Hospital, Bali, Indonesia. Patients aged 1-18 yr were included in this study. The HbA1c and serum iron levels were evaluated in the blood samples. Spearman and partial correlation analyses were used to analyze the correlations between variables. The statistical significance was set at P < 0.05. Thirty-three subjects were analyzed, with a mean age of 11.24 ± 3.76 yr. Low serum iron and poor glycemic index were found in 54.5% and 69.7% of the subjects, respectively. Spearman correlation analysis revealed a low negative correlation between the serum iron and HbA1c levels (Spearman's rho = -0.376, P = 0.031). A partial correlation showed a moderate negative correlation (r = -0.473, P = 0.013) after adjusting for confounding variables. This study found a moderate negative correlation between the serum iron and HbA1c level in children and adolescents with T1DM.

New clusters of serum electrolytes aid in stratification of diabetes and metabolic risk.

BackgroundSerum electrolytes were found to associate with type 2 diabetes. Our study aimed to stratify nondiabetes by clusters based on multiple serum electrolytes and evaluate their associations with risk of developing diabetes and longitudinal changes in glucose and lipid metabolic traits.MethodsWe performed a data‐driven cluster analysis in 4937 nondiabetes individuals aged ≥40 years at baseline from a cohort follow‐up for an average of 4.4 years. Cluster analysis was based on seven commonly measured serum electrolytes (iron, chlorine, magnesium, sodium, potassium, calcium, and phosphorus) by using the k‐means method.ResultsA total of 4937 nondiabetes individuals were classified into three distinct clusters, with 1635 (33.1%) assigned to Cluster A, 1490 (30.2%) to Cluster B, and 1812 (36.7%) to Cluster C. Individuals in Cluster A had higher serum chlorine, were older, and more were women. Individuals in Cluster B had higher serum iron and body mass index (BMI). Individuals in Cluster C had higher serum phosphorus, were younger, and had lower BMI. Cluster B had 1.41‐fold higher risk of developing diabetes and Cluster C’s risk was 1.33‐fold higher compared with Cluster A. Over an average follow‐up of 4.4 years, Cluster A showed a moderate and stable BMI, Cluster B showed an accelerated deterioration in glucose metabolism, and Cluster C showed the most sharply increased serum low‐density lipoprotein cholesterol level.ConclusionsClusters based on seven common serum electrolytes differed in diabetes risk and progression of glucose and lipid metabolic traits. Serum electrolytes clusters could provide a powerful tool to differentiate individuals into different risk stratification for developing type 2 diabetes.

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

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

Serum iron indices in COVID-19-associated mucormycosis: A case-control study.

BackgroundWhether dysregulated iron metabolism is associated with COVID‐19‐associated mucormycosis (CAM) remains unknown. Herein, we compare the serum iron indices in COVID‐19 subjects with and without mucormycosis.MethodsWe conducted a case–control study enrolling COVID‐19 participants with and without mucormycosis. We compared the baseline serum iron indices (iron, ferritin, total iron‐binding capacity [TIBC], unsaturated iron‐binding capacity and percentage transferrin saturation) between CAM cases and COVID‐19 controls. Additionally, we performed a multivariate logistic regression analysis to assess whether any iron indices are associated with CAM.ResultsWe enrolled 28 CAM cases (mean age 53.6 years old; 78.6% men) and 26 controls (mean age 57.2 years old; 73.1% men). Rhino‐orbital (±cerebral) mucormycosis (85.7%) was the most clinical presentation. Diabetes mellitus was more frequent in the cases than controls (75% vs. 42.3%; p = .015). Hypoxaemia during COVID‐19 illness was more common in controls than cases. The mean serum iron values (33 vs. 45 μg/dl, p = .03) and TIBC (166.6 vs. 201.6 μg/dl, p = .003) were significantly lower in CAM cases than controls. On multivariate analysis, we found a lower TIBC (odds ratio [OR] 0.97; 95% confidence interval [CI], 0.95–0.99) and diabetes mellitus (OR 5.23; 95% CI, 1.21–22.68) to be independently associated with CAM after adjusting for serum iron, ferritin and glucocorticoid therapy. The case fatality rate of CAM was 73.9%. The iron indices were not significantly different between CAM survivors and non‐survivors.ConclusionsThe CAM is associated with lower TIBC levels than COVID‐19 subjects without mucormycosis, suggesting dysregulated iron metabolism in its pathogenesis. Further studies are required to confirm our preliminary observations.

Abstract 754: Serum iron markers in relation to hepatocellular carcinoma risk among patients with non-alcoholic fatty liver disease

Abstract Background: Hepatocellular carcinoma (HCC) is the 6th most commonly diagnosed cancer and the 3rd leading cause of cancer death in the US. Around 85-90% of primary liver cancer is HCC. Besides identified risk factors for HCC including chronic infection with hepatitis B and C virus (HBV and HCV), alcohol abuse, dietary aflatoxin exposure and hereditary hemochromatosis, nonalcoholic fatty liver disease (NAFLD) is as another important risk factor for HCC. NAFLD is a spectrum of liver disease that ranges from hepatic steatosis through non-alcoholic steatohepatitis (NASH) with or without fibrosis and may progress to cirrhosis or HCC. Iron is an essential metal and hepatocytes are its main storage site. Increased body iron from the intestine due to high dietary iron or hereditary or acquired hemochromatosis may result in hepatic iron overload. NAFLD is frequently associated with elevated serum iron indices when hepatic iron in the absence of hemochromatosis. Epidemiologic data on the association between serum iron markers and risk of HCC are sparse. The aim of the study was to examine the association of iron related serum markers with risk of HCC in NAFLD patients. We hypothesized that elevated serum iron levels, which reflects hepatic iron, are associated with increased risk of HCC among NAFLD patients. Methods: 48,328 patients with NAFLD were identified in the electronic health records (EHR) of the University of Pittsburgh Medical Center (UPMC) between 1/1/2004 to 12/31/2018. Among them, 19,908 had at least one measurement of serum iron, transferrin saturation, total iron binding capacity (TIBC) and serum ferritin. After an average 4.47 years of follow-up, 363 patients with NAFLD were diagnosed with HCC at least 30 days after measurement of iron markers. Cox proportional hazard regression was used to calculate hazard ratios (HRs) and the 95% confidence intervals (CIs) for HCC incidence associated with elevated levels of the four iron markers adjusted for age, sex, race, body mass index, history of diabetes and tobacco smoking. Results: Serum iron and transferrin saturation were significantly elevated in NAFLD patients who developed HCC compared to others who remained free of HCC during the study. The HR of HCC for elevated serum iron &amp;gt;175 mcg/dl was 3.41 (95% CI 1.48 - 7.85) compared to its normal range at 75-175 mcg/dl. Similarly, the HR for HCC associated with elevated transferrin saturation &amp;gt;35% was 2.56 (95% CI 1.49-4.39) relative to the normal range at 25-35%. The associations were not statistically significant for TIBC and serum ferritin with HCC risk. Conclusions: Elevated serum iron and transferrin saturation levels, but not TIBC or serum ferritin, were significantly associated with increased risk of developing HCC in NAFLD patients. These findings support future studies evaluating serum iron level in risk stratification of NAFLD patients at risk of HCC and potential links to pathogenesis of HCC. Citation Format: Yi-Chuan Yu, Renwei Wang, Jaideep Behari, Ada Youk, Nancy W. Glynn, Jian-Min Yuan. Serum iron markers in relation to hepatocellular carcinoma risk among patients with non-alcoholic fatty liver disease [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 754.

Preliminary Study of ADHD Biomarkers in Adults with Focus on Serum Iron and Transcranial Sonography of the Substantia Nigra.

As previous studies have reported abnormalities in the iron indices of peripheral blood and hyperechogenicity of the substantia nigra (SN) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), we aimed to examine the same in adults with ADHD using transcranial Doppler sonography (TCS). In addition, we compared the iron indices and TCS findings before and after methylphenidate (MPH) treatment. A total of 39 participants aged ≥19 years (13 patients and 26 healthy controls) were recruited from Kyung Hee University Hospital between October 2018 and September 2019. All subjects were clinically evaluated based on the ADHD diagnostic criteria in the DSM-5, the Adult ADHD Self-Report Scale, and the Diagnostic Interview for ADHD in Adults (DIVA-5). Further, the iron indices including serum iron, ferritin, and mean platelet volume were determined. Additionally, TCS focused on the midbrain and echogenicity of the SN was conducted. Follow-up for all items was conducted for five ADHD patients after MPH treatment. Patients with ADHD had significantly lower education levels (number of years) than controls. There were no statistically significant differences in serum iron indices or the echogenic area between ADHD and control groups. Further, there were no significant changes in iron indices or TCS findings after MPH medication. Unlike previous studies, this study showed no differences between patients with ADHD and controls. Therefore, it is important to determine if these null findings were due to different target populations (children vs. adults) or other factors, including ADHD subtypes.

Heart Failure Hospitalization Risk associated with Iron Status in Veterans with CKD.

CKD is an independent risk factor for heart failure. Iron dysmetabolism potentially contributes to heart failure, but this relationship has not been well characterized in CKD. We performed a historical cohort study using data from the Veterans Affairs Corporate Data Warehouse to evaluate the relationship between iron status and heart failure hospitalization. We identified a CKD cohort with at least one set of iron indices between 2006 and 2015. The first available date of serum iron indices was identified as the study index date. The cohort was divided into four iron groups on the basis of the joint quartiles of serum transferrin saturation (shown in percent) and ferritin (shown in nanograms per milliliter): reference (16%-28%, 55-205 ng/ml), low iron (0.4%-16%, 0.9-55 ng/ml), high iron (28%-99.5%, 205-4941 ng/ml), and function iron deficiency (0.8%-16%, 109-2783 ng/ml). We compared 1-year heart failure hospitalization risk between the iron groups using matching weights derived from multinomial propensity score models and Poisson rate-based regression. A total of 78,551 veterans met the eligibility criteria. The covariates were well balanced among the iron groups after applying the propensity score weights (n=31,819). One-year adjusted relative rate for heart failure hospitalization in the iron deficiency groups were higher compared with the reference group (low iron: 1.29 [95% confidence interval, 1.19 to 1.41]; functional iron deficiency: 1.25 [95% confidence interval, 1.13 to 1.37]). The high-iron group was associated with lower 1-year relative rate of heart failure hospitalization (0.82; 95% confidence interval, 0.72 to 0.92). Furthermore, the association between iron deficiency and heart failure hospitalization risk remained consistent regardless of the diabetes status or heart failure history at baseline. Iron deficiency, regardless of cause, was associated with higher heart failure hospitalization risk in CKD. Higher iron status was associated with lower heart failure hospitalization risks.

Prolonged exposure to welding fumes as a novel cause of systemic iron overload.

Background & AimsInhalation of welding fume may cause pulmonary disease known as welder's lung. At our centre we came across a number of welders with systemic iron overload and prolonged occupational history and we aimed at characterizing this novel clinical form of iron overload.MethodsAfter exclusion of other known causes of iron overload, 20 welders were fully evaluated for working history, hepatic, metabolic and iron status. MRI iron assessment was performed in 19 patients and liver biopsy in 12. We included 40 HFE‐HH patients and 24 healthy controls for comparison.Results75% of patients showed lung HRCT alterations; 90% had s‐FERR > 1000 ng/mL and 60% had TSAT > 45%. Liver iron overload was mild in 8 and moderate‐severe in 12. The median iron removed was 7.8 g. Welders showed significantly lower TSAT and higher SIS and SIS/TIS ratio than HFE‐HH patients. Serum hepcidin was significantly higher in welders than in HFE‐HH patients and healthy controls. At liver biopsy, 50% showed liver fibrosis that was mild in four, and moderate‐severe in two. Liver staging correlated with liver iron overload.ConclusionsWelders with prolonged fume exposure can develop severe liver iron overload. The mechanism of liver iron accumulation is quite different to that of HFE‐HH suggesting that reticuloendothelial cells may be the initial site of deposition. We recommend routine measurement of serum iron indices in welders to provide adequate diagnosis and therapy, and the inclusion of prolonged welding fume exposure in the list of acquired causes of hyperferritinemia and iron overload.

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

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

A novel nutritional risk score and prognosis of oral cancer patients: A prospective study.

To evaluate the prognostic performance of a novel nutritional risk score based on serum iron, hemoglobin, and body mass index (BMI) in oral cancer patients, and to predict the response to chemotherapy in patients with different nutritional status. X-tile analysis was performed to determine the optimal cutoff values of serum iron, hemoglobin, and BMI. A nutritional risk score was established by using the HR values of serum iron, hemoglobin, and BMI. Kaplan-Meier curve and multivariable Cox proportional hazards models were used to evaluate the prognostic value of the nutritional risk score in overall survival (OS) and oral cancer-specific survival (OCSS). Serum iron, hemoglobin, and body mass index were all inversely related to the prognosis of oral cancer. The adjusted HR of serum iron, hemoglobin, and BMI were 1.562, 1.886, and 1.465 for OS, and 1.653, 1.865, and 1.443 for OCSS. Patients with higher nutritional risk score had a poorer OS and OCSS. Additionally, chemotherapy was only associated with improved OCSS in patients with the lowest nutritional risk score, but not in patients with higher one. Nutritional risk score is of prognostic value in oral cancer patients. Favorable response to chemotherapy may only be observed in well-nourished oral cancer patients with lower nutritional risk score.

Serum iron deficiency and 25-hydroxyvitamin D deficiency as an independent risk factor for osteoporosis in postmenopausal Arab women

BackgroundIron deficiency and 25-hydroxyvitamin D (25(OH)D) deficiency are among the most common nutrient deficiencies in the world. Osteoporosis, a major bone disorder, is prevalent globally as well as in Saudi Arabia. The relationship between these micronutrient deficiencies with osteoporosis is less investigated. Hence, the current study aimed to determine the relationship between iron and 25(OH)D deficiencies among postmenopausal Saudi women with osteoporosis and their associations with bone biomarkers. MethodologyA total of 184 postmenopausal Saudi women ≥ 45 years old [N = 75 osteoporosis group; N = 109 without osteoporosis or control group] were enrolled in this cross-sectional study. Anthropometrics and bone mineral density were measured. Serum iron indices, 25(OH)D and bone biomarkers [β-carboxyterminal telopeptide of type 1 collagen (β-crosslap), osteocalcin (OC), osteoprotegerin (OPG), osteopontin (OPN) and bone-specific alkaline phosphatase (BsALP) were determined. ResultsIn all subjects, significant associations were observed between serum iron and OC (r = 0.19; p = 0.02) as well as OPN (r = 0.17; p = 0.05). Also, serum 25(OH)D was inversely associated with BsALP (r = −0.25; p = 0.02), and positively with β-crosslap (r = 0.38; p = 0.01). An inverse significant association was observed between 25(OH)D and OPG (r = −0.25; p = 0.01) in the control group and BsALP (r = −0.31; p = 0.02) in the osteoporosis group. ConclusionSignificant associations between circulating iron and 25(OH)D with select bone biomarkers were observed in postmenopausal Arab women with osteoporosis, suggesting that these micronutrients may affect bone metabolism.

The Effects of Delayed Cord Clamping on 12-Month Brain Myelin Content and Neurodevelopment: A Randomized Controlled Trial.

This study aimed to determine if delayed cord clamping (DCC) affected brain myelin water volume fraction (VFm) and neurodevelopment in term infants. This was a single-blinded randomized controlled trial of healthy pregnant women with term singleton fetuses randomized at birth to either immediate cord clamping (ICC) (≤ 20 seconds) or DCC (≥ 5 minutes). Follow-up at 12 months of age consisted of blood work for serum iron indices and lead levels, a nonsedated magnetic resonance imaging (MRI), followed within the week by neurodevelopmental testing. At birth, 73 women were randomized into one of two groups: ICC (the usual practice) or DCC (the intervention). At 12 months, among 58 active participants, 41 (80%) had usable MRIs. There were no differences between the two groups on maternal or infant demographic variables. At 12 months, infants who had DCC had increased white matter brain growth in regions localized within the right and left internal capsules, the right parietal, occipital, and prefrontal cortex. Gender exerted no difference on any variables. Developmental testing (Mullen Scales of Early Learning, nonverbal, and verbal composite scores) was not significantly different between the two groups. At 12 months of age, infants who received DCC had greater myelin content in important brain regions involved in motor function, visual/spatial, and sensory processing. A placental transfusion at birth appeared to increase myelin content in the early developing brain. · DCC resulted in higher hematocrits in newborn period.. · DCC appears to increase myelin at 12 months.. · Gender did not influence study outcomes..

Intravenous iron and chronic obstructive pulmonary disease: a randomised controlled trial

BackgroundIncreased iron availability modifies cardiorespiratory function in healthy volunteers and improves exercise capacity and quality of life in patients with heart failure or pulmonary hypertension. We hypothesised that intravenous iron...

Association between Bone Mineral Density and Serum Iron Indices in Premenopausal Women in South Korea.

BackgroundOsteoporosis is characterized by a decrease in bone mineral density (BMD) and increased risk of fragility fractures. Serum iron level may interact with bone health status. This study investigated the correlations of BMD with serum iron level, hemoglobin level, and total iron-binding capacity (TIBC).MethodsWe performed a retrospective analysis of data from the medical records of premenopausal women in South Korea. The women’s BMDs and the Z scores of the BMDs were verified using dual-energy X-ray absorption. The participants were stratified into quartiles for analyses of the associations of BMD with serum iron level, TIBC, and hemoglobin level.ResultsA simple linear regression analysis revealed associations of changes in BMD with iron level (β=-0.001, standard error [SE]=0.001, P<0.001), hemoglobin level (β=0.015, SE=0.003, P<0.001), and TIBC (β=0.001, SE=0.001, P<0.001). This pattern was also observed in a multiple linear regression analysis. A multivariate logistic regression analysis of iron level and TIBC for low BMD revealed odds ratios of 1.005 (P<0.001) and 0.995 (P<0.001), respectively.ConclusionThis study demonstrated clear relationships of changes in BMD with serum iron level and TIBC, and thus confirms the usefulness of these markers in the clinical evaluation of iron storage and BMD in younger women.

P157 Altered iron homeostasis and pulmonary haemodynamics in systemic sclerosis associated pulmonary arterial hypertension

Abstract Background Iron deficiency (ID) is more prevalent in systemic sclerosis (SSc) patients with pulmonary hypertension (PH) than those without and associated with worse prognosis. Few data are available about the relationship between serum iron parameters and pulmonary haemodynamics. Methods Right heart catheterisation (RHC) reports of SSc patients were retrospectively reviewed. Subjects were included in the study if they had serum iron studies done within 12 months of RHC and were either diagnosed as 1) pulmonary arteral hypertension (PAH, group 1 PH), defined as mean pulmonary artery pressure (mPAP)≥25 mmHg at rest with pulmonary artery wedge pressure ≤15 mmHg; or 2) no PH. Patients with gastrointestinal disorders that may cause low iron levels and glomerular filtration rate below 60 ml/min/1.73m2 were excluded. We recorded serum iron concentration (µmol/L), total iron-binding capacity (TIBC, µmol/L), transferrin saturation (TS, %), ferritin (µg/L), red cell distribution width (RDW, %), as well as mPAP (mmHg) and pulmonary vascular resistance (PVR, dynes/sec/cm-5). Univariable assocıatıons were assessed using Mann-Whitney test and Spearman's correlation as appropriate. Multiple regression of log-transformed mPAP and PVR and Cox regression were used to compare iron and RDW association with haemodynamics and survival. Results We included 122 subjects in the analysis, 84% were female and mean age at RHC was 57 years. The majority (73%) had limited cutaneous SSc and 34% carried anti-centromere antibodies, followed by 18% with anti-Scl70 and 8% with anti-U3RNP.At RHC, 53/122 (43%) of the patients were diagnosed with PAH. Among them we observed substantially lower levels of serum iron (8.7 vs. 12.1 µmol/L, p &amp;lt; 0.001), TS (15.3% vs. 22.5%, p &amp;lt; 0.001), ferritin (68.1 vs. 112.5 µg/L, p = 0.07), significantly higher RDW (16.4% vs. 14.8%, p &amp;lt; 0.001) and no difference in TIBC (57.4 vs. 54.3 µmol/L, p = 0.163), compared to subjects in whom PH was excluded. mPAP showed moderately strong negative correlation with iron concentration (Spearman's rho=-0.35, p &amp;lt; 0.001) and TS (Spearman's rho=-0.39, p &amp;lt; 0.001) and positive correlation with RDW (Spearman's rho=0.46, p &amp;lt; 0.001).PVR was significantly inversely correlated with iron concentration (Spearman's rho=-0.30, p = 0.001), TS (Spearman's rho=-0.37, p &amp;lt; 0.001 and ferritin (Spearman's rho=-0.22, p = 0.016), while it showed positive correlation with TIBC (Spearman's rho=0.28, p = 0.003) and RDW (Spearman's rho=0.37, p &amp;lt; 0.001).Compared to serum iron indices, RDW is a better predictor of mPAP and PVR. In addition, iron levels did not demonstrate any association with survival, while risk of death was significantly higher for patients with higher RDW (HR = 1.18, p = 0.002) and the association remained after adjusting for presence of PH (HR = 1.16, p = 0.013). Conclusion To our knowledge, this is the first study to demonstrate a significant relationship between ID state and haemodynamic measures of SSc-PAH. Our data also support RDW, as an indicator for functional iron deficiency, may serve as a biomarker for severity of pulmonary vasculopathy in SSc. Disclosures A. Sari None. S.I. Nihtyanova None. B.E. Schreiber None. G. Coghlan None. C.P. Denton None. V.H. Ong None.

Efficacy of Oral Iron Replacement Therapy in Pediatric Patients with Heart Failure

Iron deficiency (ID) is associated with worse outcomes in children with systolic heart failure (HF). Oral iron replacement therapy (IRT) is first line therapy for ID in children but the efficacy of oral IRT in children with HF is unknown. We hypothesized that less than half of children with HF and ID would have replenishment of their iron stores with oral IRT. We performed a single center retrospective cohort study of patients aged ≤ 21 years with systolic HF and ID who received oral IRT (2-5mg/kg/day) between 01/2017 and 12/2018. ID was defined as ≥2 of the following: serum iron <50 mcg/dL, serum ferritin <20 ng/mL, transferrin >300 ng/mL, transferrin saturation <15%. Iron studies and hematologic indices pre and post IRT were compared in patients who received ≥6 weeks of therapy (to allow adequate duration of IRT to assess response) using paired-samples Wilcoxon test. Forty-two independent courses of oral IRT (in 40 patients) met inclusion criteria. The cohort was 52% male with median age 13 yrs (IQR 5 - 16 yrs). HF etiologies included cardiomyopathy (57%), congenital heart disease (31%), and history of heart transplantation with graft dysfunction (12%). Patients received ferrous sulfate (40/42) or ferrous gluconate (2/42). Median duration of IRT was 68d (IQR 32 - 145d). Twenty-nine patients received ≥6 weeks of IRT and were included for the analysis for response to oral IRT. Post IRT iron testing was available in 18 patients and post IRT hemogram was available in 26 patients. Serum iron and hematologic indices of the overall cohort as well as comparison of indices pre and post oral IRT are shown (Table). While there was an improvement in serum iron studies, 50% (9/18) of the patients remained iron deficient. This is the first report about oral IRT in children with HF. Though median values of some iron parameters increased after 6weeks of oral IRT, half of the children with HF remained iron deficient and hence non-responsive to oral IRT. Further studies are needed to find the most suitable IRT for children with HF.

Serum Iron Indices in Patients with Oral Submucous Fibrosis- A Comparative Study

Introduction: Oral submucous fibrosis (OSMF) is a potentially malignant disorder whose etiopathogenesis is still under investigation. Studies have reported altered serum iron levels in patients with OSMF. Hence, iron has been proposed to play an important role in the incidence and progression of the disease. This study was undertaken to understand the role of iron in the etiopathogenesis of OSMF by estimating haemoglobin and serum iron indices (serum iron, Total iron binding capacity [TIBC], percentage transferrin saturation and serum ferritin) in subjects with OSMF. Materials and Methods: Study group comprised of patients with histopathologically confirmed OSMF (n = 30). Age and sex matched subjects with clinically normal mucosa were selected as control group (n = 15). Hemoglobin, serum ferritin, serum iron, and TIBC were estimated (Siemens Dimension RXL Max Integrated chemistry system™). Statistical analysis used: SPSSv16 was used for statistical analysis. Independent sample t test was performed to compare the values between the study group and control group. ‘p’ value less than 0.05 was considered to be statistically significant. Results: There was a significant decrease in the haemoglobin, serum iron percentage transferrin saturation, serum ferritin levels and an increase in TIBC levels in the study (OSMF) group when compared to the control group (P

Evaluation of Urinary Hepcidin as a Marker for the Early Diagnosis of Iron Deficiency Anemia in Children

Background: Iron deficiency is an essential element, because nearly all living organism urine hepcidin levels could potentially be used in the determination of iron requirements and be an accurate indicator of physiological IDA. Aim: The present study aimed to evaluate the role of urinary hepcidin as an early diagnostic marker of iron deficiency anemia in children. Methods: This study included 45 children. Their age ranged from 6 to 16 years with hemoglobin levels ≤ 11.5 gm/dL and ferritin levels ≤ 20 ng/mL. The diagnostic performance of urinary hepcidin was estimated by analyzing the receiver operating characteristic curve. Diagnostic cut-off point with a high predictive value for iron deficiency was selected. Results: This study showed no statistically significant difference between the two studied groups regarding to demographic data. There were decrease in serum iron, ferritin, hemoglobin and Red blood cells (RBCs) indices in patient than the control group. There was non-significant decrease in urinary hepcidin in the study group compared to control group. The sensitivity and specificity of urinary hepcidin in diagnoses of iron deficiency anemia was 57.8 and 62.2 respectively with positive predictive value (63.3) in our study. There was positive correlation between urinary hepcidin and mean corpuscular volume (MCV), (r = 0.221), (p = 0.036), with the cut of value Conclusion: We concluded that the decrease of urinary level of hepcidin was non-significant in iron deficiency anemia compare to control group and needed further researches.

Анализ рекомендаций ВОЗ по использованию концентраций сывороточного ферритина для оценки статуса железа с позиции медицины 5П

According to the World Health Organization statistics, iron deficiency is among 10 most dangerous risk factors of developing various diseases, disability, and mortality throughout the world. Therefore, a correct determination of iron status in clinical practice is of decisive importance for diagnosis and screening in order to work out preventive and therapeutic measures. The new WHO guidelines emphasize the significance of monitoring the levels of ferritin, and also of serum iron, haemoglobin, transferrin, transferrin saturation, and inflammatory index in order to correctly assess iron status. The most vulnerable groups (small infants and pregnant women) have been identified, which should be given special attention with regard to monitoring iron metabolism. Key words: anaemia, haemochromatosis, iron deficiency, ferritin