Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients

Moudhi Alroomi 1, Rajesh Rajan 2, Abdulaziz A Omar 3, Ahmad Alsaber 4, Jiazhu Pan 4, Mina Fatemi 5, Kobalava D Zhanna 6, Wael Aboelhassan 7, Farah Almutairi 8, Naser Alotaibi 9, Mohammad A Saleh 8, Noor AlNasrallah 9, Bader Al-Bader 8, Haya Malhas 10, Maryam Ramadhan 11, Mohammed Abdullah 1, Hassan Abdelnaby 12 13

Affiliations

01 December 2021

-

doi: 10.1002/iid3.517

Abstract

Introduction: This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels.

Methods: Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000).

Results: Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21-0.62; p < .001), male sex (OR = 2.63, 95% CI = 1.43-5.06; p = .003), hypertension (OR = 4.16, 95% CI = 2.42-7.36; p < .001) and pneumonia (OR = 8.48, 95% CI = 3.02-35.45; p < .001) had significance in predicting in-hospital mortality. Additionally, the Cox proportional hazards analysis and Kaplan-Meier survival probability plot showed a higher mortality rate among patients with ferritin levels > 1000.

Conclusion: In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity.

Keywords: COVID-19; SARS-CoV-2; ferritin; hypertension; in-hospital mortality; male sex; pneumonia.

Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1 Kaplan–Meier survival plot of mortality grouped by fertility

Figure 1 Kaplan–Meier survival plot of mortality grouped by fertility

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References

  1.  
    1. Imran MM, Ahmed U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio—a marker of COVID‐19 pneumonia severity. Int J Clin Pract. 2020;75(4):1‐15. - PubMed
  2.  
    1. Li Z, Long F, Yang Y, Chen X, Xu L, Yang M. Serum ferritin as an independent risk factor for severity in COVID‐19 patients. J Infect. 2020;81(4):647‐679. - PMC - PubMed
  3.  
    1. Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. Res J Med Sci. 2014;19(2):164‐174. - PMC - PubMed
  4.  
    1. Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID‐19 patients. Diabetes Res Clin Pract. 2020;164:108214. - PMC - PubMed
  5.  
    1. Ma A, Jia R, Ma X, Sun Y, Zhang H, Ma Y. Iron storage in women is positively correlated with aging and BMI values. Energy Nutr Metab. 2016;30(S1):377‐382.
  6.  
    1. Wu J, Liu J, Zhao X, et al. Clinical characteristics of imported cases of coronavirus disease 2019 (COVID‐19) in Jiangsu Province: a multicenter descriptive study. Clin Infect Dis. 2020;71(15):706‐712. - PMC - PubMed
  7.  
    1. Al‐Jarallah M, Rajan R, Saber AAl, et al. In‐hospital mortality in SARS‐CoV‐2 stratified by hemoglobin levels: a retrospective study. eJHaem. 2021:1‐5. - PMC - PubMed
  8.  
    1. Al‐Jarallah M, Rajan R, Dashti R, et al. In‐hospital mortality in SARS‐CoV‐2 stratified by serum 25‐hydroxy‐vitamin D levels: a retrospective study. J Med Virol. 2021:1‐6. 10.1002/jmv.27133 - DOI - PMC - PubMed
  9.  
    1. Laine T, Reyes EM. Tutorial: survival estimation for Cox regression models with time‐varying coefficients using SAS and R. J Stat Softw. 2014;61:1‐23.
  10.  
    1. Rasyid H, Sangkereng A, Harjianti T, Soetjipto AS. Impact of age to ferritin and neutrophil‐lymphocyte ratio as biomarkers for intensive care requirement and mortality risk in COVID‐19 patients in Makassar, Indonesia. Physiol Rep. 2021;9:e14876. - PMC - PubMed
  11.  
    1. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH across speciality collaboration, UK. COVID‐19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;28395(10229):1033‐1034. - PMC - PubMed
  12.  
    1. Fox SE, Akmatbekov A, Harbert JL, et al. Pulmonary and cardiac pathology in Covid‐19: the first autopsy series from New Orleans. medRxiv. 2020;20050575.
  13.  
    1. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934‐943. - PMC - PubMed
  14.  
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID‐19 in Wuhan, China: a retrospective cohort study. Lancet. 2020. 28;395(10229):1054‐1062. - PMC - PubMed
  15.  
    1. Sun L, Shen L, Fan J, et al. Clinical features of patients with coronavirus disease 2019 from a designated hospital in Beijing, China. J Med Virol. 2020;395(10223):497‐506.
  16.  
    1. Cecconi M, Piovani D, Brunetta E, et al. Early predictors of clinical deterioration in a cohort of 239 patients hospitalized for Covid‐19 infection in Lombardy, Italy. J Clin Med. 2020;9(8):2429. - PMC - PubMed
  17.  
    1. Hou H, Zhang B, Huang H, et al. Using IL‐2R/lymphocytes for predicting the clinical progression of patients with COVID‐19. Clin Exp Immunol. 2020;201:76‐84. - PMC - PubMed
  18.  
    1. Huang S, Wang J, Liu F, et al. COVID‐19 patients with hypertension have more severe disease: a multicenter retrospective observational study. Hypertens Res. 2020;43:824‐831. - PMC - PubMed
  19.  
    1. Phipps MM, Barraza LH, LaSota ED, et al. Acute liver injury in COVID‐19: prevalence and association with clinical outcomes in a large U.S. cohort. Hepatology. 2020;72(3):807‐817. - PMC - PubMed
  20.  
    1. Ayanian S, Reyes J, Lynn L, Teufel K. The association between biomarkers and clinical outcomes in novel coronavirus pneumonia in a US cohort. Biomark Med. 2020;14(12):1091‐1097. - PMC - PubMed
  21.  
    1. Meng Y, Lu W, Guo E, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID‐19 patients: a propensity score‐matched analysis. J Hematol Oncol. 2020;13:75. - PMC - PubMed
  22.  
    1. Cheng L, Li H, Li L, et al. Ferritin in the coronavirus disease 2019 (COVID‐19): a systematic review and meta‐analysis. J Clin Lab Anal. 2020;34:e23618. - PMC - PubMed

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