Elevated serum ferritin level effectively discriminates severity illness and liver injury of coronavirus disease 2019 pneumonia

Study on ferritin and liver injury in pediatric hemophagocytic lymphohistiocytosis associated with infection

Summarize and analyze the clinical characteristics of children with infection-associated hemophagocytic lymphohistiocytosis (IAHLH) complicated by liver injury, and investigate the correlation between ferritin (FERR) and liver injury indicators. A total of 90 children with IAHLH admitted to Hebei Children's Hospital from November 1, 2017 to September 30, 2024 were selected as the research subjects. The patients were divided into liver injury group and non-liver injury group based on the presence of liver damage. The clinical features and laboratory test differences between the two groups were analyzed, and the correlation between ferritin and liver injury markers was investigated. (1) Among the 90 cases of IAHLH, 61cases (67.8%) were complicated by liver injury. In the liver injury group, FERR and D-dimer (DD) were significantly higher than those in the non-liver injury group (P < 0.05), while fibrinogen (FIB) and albumin were significantly lower (P < 0.05). Moreover, the liver injury group was more likely to develop to multiple organ dysfunction syndrome (MODS) (P = 0.021). (2) FERR was positively correlated with indicators such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and DD (P < 0.05), and negatively correlated with indicators such as albumin (ALB) (P < 0.05). FERR has a certain correlation with liver injury in pediatric hemophagocytic lymphohistiocytosis associated with infection. Monitoring FERR can help evaluate the degree of liver injury and alert to the occurrence of MODS, providing a basis for early clinical intervention.

Evaluation of CoVid-19 infection among vaccinated and unvaccinated individuals using biochemical markers

The evaluation of infection rate for CoVid-19 cases among vaccinated and unvaccinated individuals using haematological parameters is of interest. Data such as age, gender, occupation, location, signs and symptoms, length of symptoms, date of sample collection and report generation, status of vaccinations, and outcome available in the database was used in this analysis. Ferritin levels, D-dimer values, CRP, troponin-1 levels and platelet count of each CoVid-19 patient were recorded and analysed. Data shows that maximum number of cases was reported during the second wave 143 (51.07%). The common age group affected was 31-40 years 28.56%. The common symptom identified was weakness in arms and legs among the unvaccinated group of CoVid-19 positive group. However, common symptom identified was fatigue (87%) among those who received only the first dose of CoVid vaccine. Nonetheless, the symptom identified was hair loss (68%) among those who received both the doses of CoVid vaccine. Thus, data shows that people do experience severe and life-threatening COVID-19 infection despite receiving the vaccination. Nonetheless, the infection is mild and very few individuals require hospitalization. No deaths are reported in the group that received the vaccination. This is in contrast to the unvaccinated group, which had a severe CoVid-19 infection with few deaths reported.

A Comprehensive Review on Serum Ferritin as a Prognostic Marker in Intensive Care Units: Insights Into Ischemic Heart Disease

Serum ferritin has garnered considerable attention as a prognostic marker in intensive care units (ICUs), offering valuable insights into patient outcomes and clinical management strategies. This comprehensive review examines the role of serum ferritin in predicting outcomes among critically ill patients, with a particular focus on its implications for ischemic heart disease (IHD). Elevated serum ferritin levels have consistently been associated with adverse outcomes in ICU settings, including increased mortality, prolonged hospital stays, and higher morbidity rates. Furthermore, the relationship between serum ferritin levels and IHD underscores its potential as a biomarker for cardiovascular risk assessment in critically ill populations. The review synthesizes existing literature to highlight the predictive value of serum ferritin in assessing illness severity and guiding clinical decision-making in the ICUs. It also explores potential mechanisms linking serum ferritin to adverse outcomes and discusses implications for clinical practice. Integrating serum ferritin measurements into routine assessments could enhance prognostication and risk stratification in ICU patients, while further research is needed to elucidate optimal management strategies and therapeutic targets. Collaborative efforts between clinicians and researchers are essential to advance our understanding of serum ferritin's prognostic value in the ICUs and translate this knowledge into improved patient care and outcomes.

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

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

Amelioration effects of the soybean lecithin-gallic acid complex on iron-overload-induced oxidative stress and liver damage in C57BL/6J mice

CONTEXT

Gallic acid (GA) and lecithin showed important roles in antioxidant and drug delivery, respectively. A complex synthesized from GA and soybean lecithin (SL-GAC), significantly improved bioavailability of GA and pharmacological activities. However, the antioxidant activity of SL-GAC and its effect on iron-overload-induced liver injury remains unexplored.

OBJECTIVE

This study investigates the antioxidant properties of SL-GAC in vitro and in mice, and its remediating effects against liver injury by iron-overloaded.

MATERIALS AND METHODS

In vitro, free radical scavenging activity, lipid peroxidation inhibition, and ferric reducing power of SL-GAC were measured by absorbance photometry. In vivo, C57BL/6J mice were randomized into 4 groups: control, iron-overloaded, iron-overloaded + deferoxamine, and iron-overloaded + SL-GAC. Treatments with deferoxamine (150 mg/kg/intraperitioneally) and SL-GAC (200 mg/kg/orally) were given to the desired groups for 12 weeks, daily. Iron levels, oxidative stress, and biochemical parameters were determined by histopathological examination and molecular biological techniques.

RESULTS

In vitro, SL-GAC showed DPPH and ABTS free radicals scavenging activity with IC₅₀ values equal to 24.92 and 128.36 μg/mL, respectively. In C57BL/6J mice, SL-GAC significantly reduced the levels of serum iron (22.82%), liver iron (50.29%), aspartate transaminase (25.97%), alanine transaminase (38.07%), gamma glutamyl transferase (42.11%), malondialdehyde (19.82%), total cholesterol (45.96%), triglyceride (34.90%), ferritin light chain (18.51%) and transferrin receptor (27.39%), while up-regulated the levels of superoxide dismutase (24.69%), and glutathione (11.91%).

CONCLUSIONS

These findings encourage the use of SL-GAC to treat liver injury induced by iron-overloaded. Further in vivo and in vitro studies are needed to validate its potential in clinical medicine.

Analysis of Plasma Proteins Involved in Inflammation, Immune Response/Complement System, and Blood Coagulation upon Admission of COVID-19 Patients to Hospital May Help to Predict the Prognosis of the Disease

The development of new approaches allowing for the early assessment of COVID-19 cases that are likely to become critical and the discovery of new therapeutic targets are urgently required. In this prospective cohort study, we performed proteomic and laboratory profiling of plasma from 163 COVID-19 patients admitted to Bauru State Hospital (Brazil) between 4 May 2020 and 4 July 2020. Plasma samples were collected upon admission for routine laboratory analyses and shotgun quantitative label-free proteomics. Based on the course of the disease, the patients were divided into three groups: (a) mild (n = 76) and (b) severe (n = 56) symptoms, whose patients were discharged without or with admission to an intensive care unit (ICU), respectively, and (c) critical (n = 31), a group consisting of patients who died after admission to an ICU. Based on our data, potential therapies for COVID-19 should target proteins involved in inflammation, the immune response and complement system, and blood coagulation. Other proteins that could potentially be employed in therapies against COVID-19 but that so far have not been associated with the disease are CD5L, VDBP, A1BG, C4BPA, PGLYRP2, SERPINC1, and APOH. Targeting these proteins' pathways might constitute potential new therapies or biomarkers of prognosis of the disease.

Association of Serum Ferritin With Severity of Disease in Real-Time Reverse Transcription-Polymerase Chain Reaction Negative COVID-19 Patients

BACKGROUND

Coronavirus disease 2019 (COVID-19) is still causing disastrous effects in various parts of the world through recurring waves. Real-time reverse transcription polymerase chain reaction (RT-PCR)-negative COVID-19 is particularly challenging as these patients are less likely to receive treatment and more likely to progress to severe disease. Thus, it is imperative to find markers that can predict the severity of disease at an early stage. The objective of the present study was to analyze the association of ferritin levels with severe disease in RT-PCR-negative COVID-19 patients.

METHODS

A prospective cross-sectional analytical study was conducted in adults with COVID-19 pneumonia with a negative RT-PCR test from October 2020 to September 2021. Hematologic, biochemical, and inflammatory parameters were investigated within 24 h of hospitalization. Demographic, clinical, and laboratory findings were compared between patients with and without severe disease.

RESULTS

A total of 220 patients were included. The mean age of the study participants was 47.3 ± 14.2 years, and 55.5% (n=122) were male. C-reactive protein, D-dimer, and ferritin levels were significantly higher in patients with severe disease (p<0.01). Receiver operating characteristic curve analyses were performed, and ferritin was found as significant predictor of severe disease (area under the curve=0.642, p<0.001).

CONCLUSION

Early analysis of ferritin can predict the severity of disease in COVID-19 patients, irrespective of the RT-PCR status.

Association of serum ferritin with severity and clinical outcome in COVID-19 patients: An observational study in a tertiary healthcare facility

Background

Ferritin, an intracellular protein, has a pivotal role in immune dysregulation. Hyperferritinemia has been associated with higher disease severity and adverse clinical outcomes in COVID-19, including mortality. We aimed to study the association of serum ferritin levels with disease severity and clinical outcomes and its severity prediction potential in COVID-19 patients.

Methods

This retrospective study included 870 adult patients with symptomatic COVID-19 infection hospitalized between July 1, 2020 to December 21, 2020. All the patients had a positive polymerase chain reaction test result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Results

The median age was 55 (IQR:40, 65) years with a male predominance [66.32% (n = 577)], among 870 COVID-19. Of these, 413 (47.47%) had mild COVID-19, and 457 (52.53%) had moderate plus severe COVID-19 disease. Median ferritin levels were significantly high in moderate to severe COVID-19 infection compared to mild [545.8 (326.0, 1046.0) vs 97.3 (52.65-155.5) (p = 0.001)], and in patients who developed a complication compared to without complications [380 (177.05, 863.15) vs 290 (110.9, 635) (p = 0.002). A slight elevation in median ferritin levels was observed in patients who had an ICU stay than non-ICU [326 (129.8, 655) vs 309 (119.1, 684) (p = 0.872)]. The cut-off for ferritin was identified at >287.4 ng/ml for mild versus moderate plus severe COVID-19 infections.

Conclusion

Moderate to severe COVID-19 patients have elevated ferritin levels. Patients with more than 287.4 ng/ml ferritin value would have greater chances of developing moderate to severe COVID-19 infections.

Value of combined detection of peripheral blood monocyte chemotactic protein-1, high mobility group protein-1, and ferritin in diagnosis and assessment of drug-induced liver injury

BACKGROUND

Early and accurate diagnosis and assessment of drug-induced liver injury (DILI) are of important significance for its clinical management. The mechanism of DILI is complex and involves a variety of molecules. Serum ferritin (SF), monocyte chemotactic protein-1 (MCP-1), and high mobility group protein-1 (HMGB1) are significantly elevated in liver injury and may be associated with DILI.

AIM

To investigate the diagnostic value of peripheral blood SF, MCP-1, and HMGB1 in DILI.

METHODS

One hundred and eighty-four patients with DILI admitted to our hospital from January 2018 to February 2021, including 94 mild patients (mild group), 52 moderate patients (moderate group), and 38 severe patients (severe group), 70 patients with alcoholic liver disease or non-alcoholic fatty liver disease treated in the same period (non-DILI liver disease group), and 70 healthy volunteers attending the physical examination (control group) were included in this study. Serum SF, MCP-1, and HMGB1 levels were compared among the groups. Pearson correlation analysis was performed to determine the relationship between serum SF, MCP-1, and HMGB1 and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and alkaline phosphatase (ALP). Spearman correlation analysis was performed to explore the relationship between serum SF, MCP-1, and HMGB1 and the severity of DILI. Multivariate logistic regression was used to identify the factors related to the severity of DILI, and receiver operating characteristic (ROC) curve analysis was applied to assess the performance of each index and their combination in the diagnosis of DILI.

RESULTS

ALT, AST, TBIL, and ALP, as well as serum SF, MCP-1, and HMGB1, were highest in the severe group, followed by the moderate group, mild group, and control group (P < 0.05 for all pairwise comparisons). The distribution of DILI severity between patients with high and low levels of serum SF, MCP-1, and HMGB1 was significantly different (P<0.05). Serum SF (r = 0.665, P < 0.001), MCP-1 (r = 0.693, P < 0.001), and HMGB1 (r = 0.728, P < 0.001) were positively correlated with the severity of DILI. Multivariate logistic regression analysis showed that after adjusting for ALT, AST, TBIL, and ALP, serum SF, MCP-1, and HMGB1 were still factors significantly influencing the severity of DILI (P < 0.05). The area under the ROC curve (AUC) of serum SF, MCP-1, or HMGB1 alone for diagnosing DILI was 0.870, 0.803, and 0.859, respectively, and the AUC of their combination for diagnosing DILI was 0.926. For diagnosing severe DILI, the AUC of SF, MCP-1, or HMGB1 alone was 0.888, 0.774, and 0.807, respectively, and the AUC of their combination was 0.948.

CONCLUSION

Peripheral blood SF, MCP-1, and HMGB1 are related to DILI and its severity, and have high application value in DILI diagnosis and disease evaluation. They can be used as biomarkers to diagnose and evaluate the severity of DILI.

Clinical progress in MSC-based therapies for the management of severe COVID-19

Considering the high impact that severe Coronavirus disease 2019 (COVID-19) cases still pose on public health and their complex pharmacological management, the search for new therapeutic alternatives is essential. Mesenchymal stromal cells (MSCs) could be promising candidates as they present important immunomodulatory and anti-inflammatory properties that can combat the acute severe respiratory distress syndrome (ARDS) and the cytokine storm occurring in COVID-19, two processes that are mainly driven by an immunological misbalance. In this review, we provide a comprehensive overview of the intricate inflammatory process derived from the immune dysregulation that occurs in COVID-19, discussing the potential that the cytokines and growth factors that constitute the MSC-derived secretome present to treat the disease. Moreover, we revise the latest clinical progress made in the field, discussing the most important findings of the clinical trials conducted to date, which follow 2 different approaches: MSC-based cell therapy or the administration of the secretome by itself, as a cell-free therapy.

Prognostic role of pretreatment serum ferritin concentration in lung cancer patients: A meta-analysis

BACKGROUND

The association between pretreatment serum ferritin concentration (SFC) and long-term survival in lung cancer remains unclear now.

AIM

To identify the prognostic value of pretreatment SFC in lung cancer patients based on current evidence.

METHODS

The PubMed, EMBASE and Web of Science databases were searched from inception to May 29, 2022 for relevant studies. The primary endpoint was overall survival (OS) and the hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were combined to assess the predictive role of pretreatment SFC for long-term survival of lung cancer patients. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

RESULTS

Twelve retrospective studies involving 1654 patients were analyzed. The results manifested that increased pretreatment SFC was associated with worse OS (HR = 1.09, 95%CI: 1.03-1.15, P = 0.004). Subgroup analysis stratified by the country (China vs non-China) showed similar results. However, subgroup analysis stratified by tumor type revealed inconsistent results (lung cancer: HR = 1.39, P = 0.008; small cell lung cancer: HR = 1.99, P = 0.175; non-small cell lung cancer: HR = 1.03, P = 0.281).

CONCLUSION

Pretreatment SFC might serve as a promising prognostic indicator in lung cancer patients and elevated pretreatment SFC predicts worse prognosis. However, more high-quality studies with big sample sizes are still needed to further verify its prognostic value in lung cancer.

COVID-19 associated liver injury: A general review with special consideration of pregnancy and obstetric outcomes

Liver injury is an increasingly recognized extra-pulmonary manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Coronavirus disease 2019 (COVID-19) associated liver injury (COVALI) is a clinical syndrome encompassing all patients with biochemical liver injury identified in the setting of SARS-CoV-2 infection. Despite profound clinical implications, its pathophysiology is poorly understood. Unfortunately, most information on COVALI is derived from the general population and may not be applicable to individuals under-represented in research, including pregnant individuals. This manuscript reviews: Clinical features of COVALI, leading theories of COVALI, and existing literature on COVALI during pregnancy, a topic not widely explored in the literature. Ultimately, we synthesized data from the general and perinatal populations that demonstrates COVALI to be a hepatocellular transaminitis that is likely induced by systemic inflammation and that is strongly associated with disease severity and poorer clinical outcome, and offered perspective on approaching transaminitis in the potentially COVID-19 positive patient in the obstetric setting.

Role of iron in the treatment of sepsis

Iron is an important microelement in human and microbial life activities. During the pathophysiological process of sepsis, iron metabolism changes and the body undergoes a series of changes to fight microbial infection. Meanwhile, alterations in iron metabolism during sepsis lead to the development of some diseases, such as transfusion-induced siderosis and anemia. In recent years, several studies have demonstrated the use of iron-chelating agents to fight microbial infections, and new antimicrobial agents have been developed using "Trojan horse" and siderophores immunity. In addition, the use of iron-based nanomaterials as drug delivery systems for gene delivery may be applied to the treatment of sepsis in the future. In this review, we describe the pathophysiological changes in the development and course of sepsis, focusing on the potential of iron in the treatment of sepsis.

Iron Chelator or Iron Supplement Consumption in COVID-19? The Role of Iron with Severity Infection

Iron is a trace element that is used to replicate the virus and has a role in the vital functions of the body and the host's innate immune system. The mechanism of iron in COVID-19 severity is still not well understood. The aim of this study was to evaluate the association of the iron with COVID-19 severity. A case-control study was performed on 147 patients with a positive PCR test result and 39 normal individuals admitted to the Persian Gulf Martyrs Hospital in Bushehr, Iran. The iron profiles and related tests were measured along with hematological analytes. Hemoglobin (Hb), Fe, and saturated transferrin decreased in all the groups compared to the controls, but ferritin increased in the patient groups. After adjusting for age and sex, we found that increased ferritin levels augmented the odds ratio (OR) of the disease in the moderate (OR = 2.95, P = 0.007), severe (OR = 6.1, P < 0.001), and critical groups (OR = 8.34, P < 0.001). The decreased levels of Fe reduced the OR of the disease in the mild (OR = 0.96, P < 0.001), moderate (OR = 0.96, P < 0.001), severe (OR = 0.95, P < 0.001), and critical (OR = 0.98, P = 0.001) groups. Fe (AUC = 85.95, cutoff < 75.5 µg/dL, P < 0.001) and ferritin (AUC = 84.45, cutoff > 157.5 ng/dL, P < 0.001) have higher AUC for disease prognosis, but only ferritin (AUC = 74.89, cutoff > 261.5 ng/dL, P < 0.001) has higher AUC for disease severity assays. It could be concluded that the use of iron chelators to reduce iron intake can be considered a therapeutic goal. In addition, measuring Fe and ferritin is beneficial for the diagnosis of the disease and determining its severity.

Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients

Vaccines against severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) infection, which causes coronavirus disease-19 (COVID-19) in humans, have been developed and are being tested for safety and efficacy. We conducted the cross-sectional prospective cohort study on 820 patients who were positive for SARS-CoV-2 and were admitted to Princess Krishnajammanni trauma care centre (PKTCC), Mysore, which was converted to a designated COVID hospital between April 2021 to July 2021. After obtaining the informed consent, RT-PCR report, vaccination certificate and patient history, patients were classified according to their vaccination status. Results from the study showed decreases in serum ferritin levels, clinical symptoms, improvement in oxygen saturation, early recovery in patients having diabetes and hypertension, and a substantial reduction in the overall duration of hospital stay in vaccinated patients compared to unvaccinated patients. Further, fully vaccinated patients showed better outcomes compared to single dose vaccinated and nonvaccinated patients. Taken together, our findings reaffirm the vaccine's effectiveness in reducing case fatality and promoting faster recovery compared to nonvaccinated patients. Efforts to increase the number of immunized subjects in the community help to achieve herd immunity and offer protection against the severity of COVID-19 and associated complications while minimizing the public health and economic burden.

Potential role of biochemical markers in the prognosis of COVID-19 patients

The global pandemic due to coronavirus disease 2019 (COVID-19) has posed an overall threat to modern medicine. The course of the disease is uncertain with varying forms of presentation that cannot be managed solely with clinical skills and vigor. Since its inception, laboratory medicine forms a backbone for the proper diagnosis, treatment, monitoring, and prediction of the severity of the disease. Clinical biochemistry, an integral component of laboratory medicine, has been an unsung hero in the disease prognosis and severity assessment in COVID-19. This review attempts to highlight the biomarkers which have shown a significant role and can be used in the identification, stratification, and prediction of disease severity in COVID-19 patients. It also highlights the basis of the use of these biomarkers in the disease course and their implications.

Dysregulation in erythrocyte dynamics caused by SARS-CoV-2 infection: possible role in shuffling the homeostatic puzzle during COVID-19

Introduction

The evolving COVID-19 pandemic became a hallmark in human history, not only by changing lifestyles, but also by enriching scientific knowledge on viral infection and its consequences.

Objective

Although the management of cardiorespiratory changes is pivotal to a favorable prognosis during severe clinical findings, dysregulation of other systems caused by SARS-CoV-2 infection may imbalance erythrocyte dynamics, such as a bidirectional positive feedback loop pathophysiology.

Method and Results

Recent evidence shows that SARS-CoV-2 is capable of affecting the genetics and dynamics of erythrocytes and this coexists with a non-homeostatic function of cardiovascular, respiratory and renal systems during COVID-19. In hypothesis, SARS-CoV-2-induced systematical alterations of erythrocytes dynamics would constitute a setpoint for COVID-19-related multiple organ failure syndrome and death.

Conclusion

The present review covers the most frequent erythrocyte-related non-homeostatic findings during COVID-19 capable of providing mechanistic clues of SARS-CoV-2-induced infection and inspiring therapeutic-oriented scientific evidence.

Ferritin - from iron, through inflammation and autoimmunity, to COVID-19

While it took decades to arrive to a conclusion that ferritin is more than an indicator of iron storage level, it took a short period of time through the COVID-19 pandemic to wonder what the reason behind high levels of ferritin in patients with severe COVID-19 might be. Unsurprisingly, acute phase reactant was not a satisfactory explanation. Moreover, the behavior of ferritin in patients with severe COVID-19 and the subsequent high mortality rates in patients with high ferritin levels necessitated further investigations to understand the role of ferritin in the diseases. Ferritin was initially described to accompany various acute infections, both viral and bacterial, indicating an acute response to inflammation. However, with the introduction of the hyperferritinemic syndrome connecting four severe pathological conditions such as adult-onset Still's disease, macrophage activation syndrome, catastrophic antiphospholipid syndrome, and septic shock added another aspect of ferritin where it could have a pathogenetic role rather than an extremely elevated protein only. In fact, suggesting that COVID-19 is a new member in the spectrum of hyperferritinemic syndrome besides the four mentioned conditions could hopefully direct further search on the pathogenetic role of ferritin. Doubtlessly, improving our understanding of those aspects of ferritin would enormously contribute to better coping with severe diseases in terms of treatment and prevention of complications. The origin, history, importance, and the advances of searching the role of ferritin in various pathological and clinical processes are presented hereby in our article. In addition, the implications of ferritin in COVID-19 are addressed.

Clinical Predictors of COVID-19 Mortality Among Patients in Intensive Care Units: A Retrospective Study

Objective

The ongoing pandemic of the coronavirus disease 2019 (COVID-19), which originated from Wuhan, China, has been identified to be caused by the novel beta coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been spreading rapidly worldwide within just a few months. Our aims were to analyze clinical and laboratory abnormalities in ICU patients with COVID-19, in order to define which predictors can distinguish between those who are at higher risk of developing fatal versus non-fatal forms of the disease.

Methods

A descriptive cross-sectional survey was used; demographics, comorbidities, symptoms, laboratory parameters at ICU admission, and clinical outcomes for the adult patients admitted to ICU were collected from five hospitals in Saudi Arabia.

Results

A total of 86 patients with COVID-19 admitted in ICU, 50 patients died, 23 recovered, and 13 were still admitted, with a mortality rate of 58.1%. Septic shock (OR (95% CI): 58.1 (5.97–7812.8), p < 0.001) and acute kidney injury (AKI) (OR (95% CI): 7.279 (1.191–65.43), p = 0.032) had a significant impact on mortality. Cox proportional-hazards regression analysis revealed that septic shock (HR (95% CI): 9.502 (2.958–30.524), p < 0.001) and neutrophil count (HR (95% CI): 1.053 (1.023–1.085), p < 0.001) were significant predictors for mortality.

Conclusion

Septic shock, AKI, and high neutrophil count were found to be predictive of death in these patients. Further studies are needed to aid efficient recognition and management of severe COVID-19 patients in our population. 

Neutralizing Autoantibodies to Type I IFNs in >10% of Patients with Severe COVID-19 Pneumonia Hospitalized in Madrid, Spain

Background

In a recent study, autoantibodies neutralizing type I interferons (IFNs) were present in at least 10% of cases of critical COVID-19 pneumonia. These autoantibodies neutralized most type I IFNs but rarely IFN-beta.

Objectives

We aimed to define the prevalence of autoantibodies neutralizing type I IFN in a cohort of patients with severe COVID-19 pneumonia treated with IFN-beta-1b during hospitalization and to analyze their impact on various clinical variables and outcomes.

Methods

We analyzed stored serum/plasma samples and clinical data of COVID-19 patients treated subcutaneously with IFN-beta-1b from March to May 2020, at the Infanta Leonor University Hospital in Madrid, Spain.

Results

The cohort comprised 47 COVID-19 patients with severe pneumonia, 16 of whom (34%) had a critical progression requiring ICU admission. The median age was 71 years, with 28 men (58.6%). Type I IFN-alpha- and omega-neutralizing autoantibodies were found in 5 of 47 patients with severe pneumonia or critical disease (10.6%), while they were not found in any of the 118 asymptomatic controls (p = 0.0016). The autoantibodies did not neutralize IFN-beta. No demographic, comorbidity, or clinical differences were seen between individuals with or without autoantibodies. We found a significant correlation between the presence of neutralizing autoantibodies and higher C-reactive protein levels (p = 5.10e⁻⁰³) and lower lymphocyte counts (p = 1.80e⁻⁰²). No significant association with response to IFN-beta-1b therapy (p = 0.34) was found. Survival analysis suggested that neutralizing autoantibodies may increase the risk of death (4/5, 80% vs 12/42, 28.5%).

Conclusion

Autoantibodies neutralizing type I IFN underlie severe/critical COVID-19 stages in at least 10% of cases, correlate with increased C-RP and lower lymphocyte counts, and confer a trend towards increased risk of death. Subcutaneous IFN-beta treatment of hospitalized patients did not seem to improve clinical outcome. Studies of earlier, ambulatory IFN-beta treatment are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10875-021-01036-0.

Can Ferritin Levels Predict the Severity of Illness in Patients With COVID-19?

Objectives: This study aimed to investigate whether ferritin level can predict the severity of coronavirus disease 2019 (COVID-19).

Background: The COVID-19 pandemic has been challenging for both patients and caregivers. Many laboratory markers have been used to better understand the causes of poor outcomes and to improve the management of COVID-19 patients.

Methods: A total of 93 patients who had a positive polymerase chain reaction test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in this study. Demographic features, comorbidities, clinical and laboratory findings were obtained from the hospital database retrospectively. Patients were divided into two groups according to the disease severity as follows: mild group (n = 70) and severe group (n = 23).

Results: The median age of the study population was 42.5 (28.3-62.8) with 69.9% male patients. Patients in the severe group were significantly older and showed a higher frequency of hypertension, diabetes mellitus, coronary artery disease, and heart failure in comparison with those in the mild group. In addition, gamma-glutamyl transferase, C-reactive protein, ferritin, interleukin-6, procalcitonin, and neutrophil to lymphocyte ratio were higher whereas albumin level was lower in patients in the severe group. Linear regression analysis demonstrated that ferritin level was the only significant predictor of disease severity (β = 0.487, t = 2.993, p = 0.004). In receiver operator characteristics curve analysis, ferritin level ≥264.5 ng/mL predicted severe COVID-19 with a sensitivity of 73.9% and specificity of 94.2%.

Conclusion: Early analysis of ferritin levels in patients with COVID-19 might effectively predict the disease severity.