Serum ferritin level as a prognostic biomarker for predicting dengue disease severity: A systematic review and meta-analysis

Association between serum ferritin and mortality in patients with severe fever with thrombocytopenia syndrome: A retrospective cohort study

The role of serum ferritin, an acute-phase inflammatory marker, in predicting mortality in patients with severe fever with thrombocytopenia syndrome (SFTS) is not fully understood. This study aimed to investigate the association between serum ferritin levels and inpatient mortality in patients with SFTS. We conducted a retrospective analysis using data from patients diagnosed with SFTS at the Second Affiliated Hospital of Anhui Medical University between May 2017 and September 2024. The association between serum ferritin levels and in-hospital mortality in patients with SFTS was assessed using Cox regression models and restricted cubic spline (RCS) analysis. The receiver operating characteristic (ROC) curve was used to determine the optimal serum ferritin cut-off value for predicting mortality risk. Kaplan-Meier survival curves were compared for survival rates, and propensity score matching with linear trend testing was applied to ensure robustness. This study included 390 patients with SFTS, of whom 312 survived and 78 did not, yielding an in-hospital mortality rate of 20.0%. Cox regression and RCS analyses demonstrated a significant linear association between higher serum ferritin levels and increased in-hospital mortality in patients with SFTS, indicating that the predicted mortality of patients with SFTS increased with elevated serum ferritin levels beyond a certain threshold. ROC analysis revealed an area under the curve of 0.830, with an optimal serum ferritin cut-off of 3.975 (lg, ng/ml), sensitivity of 0.731, and specificity of 0.830. Clinically, serum ferritin levels above 4 (lg ng/ml), were associated with a substantial increase in mortality risk. Sensitivity analysis supported the robustness of these results. Serum ferritin levels are linearly associated with mortality risk in patients with SFTS, with mortality significantly increasing when serum ferritin levels exceed 10,000 ng/ml. Serum ferritin level may serve as a valuable prognostic biomarker for mortality risk in patients with SFTS.

Oxidative stress induced liver damage in dengue is exacerbated in those with obesity

Background

Obesity and diabetes are risk factors for severe dengue. As there are limited data on the association of obesity with liver dysfunction and oxidative stress in patients with acute dengue, we investigated liver dysfunction associated with obesity, oxidative stress and inflammatory markers, in a large cohort of patients with varying severity of acute dengue.

Methods

577 adults dengue patients with acute disease, presenting with a duration of illness ≤ 4 days, were enrolled and followed up from admission to discharge, with clinical and laboratory features recorded. Aspartate transaminase (AST), alanine transaminase (ALT), C-reactive protein, ferritin, 4-hydroxynonenal (4-HNE) and malondialdehyde (MDA) levels were measured, along with the height, weight and waist circumference.

Results

AST, ALT, CRP and ferritin levels were significantly higher in patients with central obesity (waist circumference of ≥80cm in women or ≥90cm in men) compared to leaner individuals. ALT and CRP levels were also significantly higher in patients with a BMI of ≥ 23.9 kg/m2. 4-HNE levels significantly increased with the rise in AST levels and with ALT levels although not significant. In contrast, MDA levels gradually decreased with the rise in AST levels and ALT levels. There were no differences in 4-HNE and MDA levels in relation to clinical disease severity. However, MDA levels were significantly higher in younger individuals, and leaner individuals with a normal BMI. Furthermore, MDA levels inversely correlated with serum ferritin levels, while AST, ALT and CRP levels significantly correlated ferritin levels.

Conclusions

4-HNE and MDA which are markers of lipid peroxidation, appear to play different roles in the pathogenesis of dengue, which should be further investigated for identification of therapeutic targets for treatment of dengue.

Serum Ferritin in Dengue Infection

Dengue fever (DF), a significant global health issue, particularly impacts tropical and subtropical regions. Elevated serum ferritin levels are increasingly recognized as a biomarker for severe dengue infection. This review examines the role of serum ferritin in diagnosing and prognosticating dengue severity. It highlights how hyperferritinemia correlates with severe clinical outcomes, including dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). By integrating serum ferritin measurement into routine clinical practice, early identification and intervention for high-risk patients can be enhanced, potentially improving clinical outcomes. Further research should focus on standardizing ferritin level thresholds and exploring the mechanisms underlying ferritin elevation in dengue.

Serum iron concentration and leptin inversely relate, partially mediated by body mass index in American adults

Iron metabolism and leptin are interconnected, and both link with obesity. In this cross-sectional study, we hypothesized that serum iron markers associate with leptin, with body mass index (BMI) acting as a mediator, confounder, and effect modifier in this relationship. We analyzed data from the National Health and Nutrition Examination Survey III, with a focus on serum iron markers and leptin. The relationship between serum iron markers and leptin was determined by multiple linear regression. The bootstrap method was used to investigate the mediating effect of BMI on this association. Among 3888 American adults, serum iron and transferrin saturation showed a negative association with leptin (log2-transformed) (β: -0.010, 95% confidence interval [CI], -0.013 to -0.006, P < .001; β: -0.006, 95% CI, -0.008 to -0.004, P < .001). Total iron-binding capacity was positively associated with the serum concentration of leptin (log2-transformed) (β: 0.002, 95% CI, 0-0.004, P = .0292). Sex, BMI, and body fat percentage significantly influenced these associations. Notably, the association between the iron markers and leptin diminished in individuals with a BMI ≥30 kg/m2. There was no observable relationship between leptin and serum ferritin concentrations. BMI mediated 4.81% of the serum iron-leptin association, with no mediation of body fat percentage. Our study identified a link between serum iron and leptin, with BMI as a mediating factor. In clinical settings, it is vital to understand how treatments targeting iron metabolism can directly impact serum leptin concentration and the subsequent physiological changes.