The detrimental impact of elevated Ferritin to Iron ratio on in-hospital prognosis of patients with COVID-19

ABSTRACT

Background

Acute viral infections, including coronavirus disease 2019 (COVID-19), are characterized by the dysregulation of iron metabolism, resulting in high serum ferritin and low iron levels.

Research design and methods

This study aimed to evaluate the prospective impact of iron metabolism dysregulation, as expressed by serum Ferritin-to-Iron Ratio (FIR), on the in-hospital prognosis of patients with COVID-19. Serum levels of ferritin and iron, as well as other iron metabolism markers and recognized prognostic indicators of COVID-19 severity, were measured in 362 patients consecutively hospitalized for COVID-19. The prospective relationship between FIR and the risk of the composite outcome of intensive care unit (ICU) admission/in-hospital death was analyzed.

Results

In the population examined (mean age 74 ± 15 years, males 55%), the rates of radiographic signs of pneumonia, respiratory distress, and the need for noninvasive ventilation were higher in patients with high FIR (≥29.2, the 75^th percentile) than in those with low FIR (<29.2, the 75^th percentile) (p < 0.05 for all comparisons). High FIR was associated with a 1.7-fold (HR 1.709, 95% CI 1.017–2.871, p = 0.043) higher risk of ICU admission/in-hospital death.

Conclusions

Increasing FIR values significantly and independently predicts worse in-hospital prognosis in hospitalized patients with COVID-19.

KEYWORDS:

• COVID-19
• ferritin
• ferritin to iron ratio
• inflammation
• iron
• SARS-CoV-2

Author contributions

Conception and design: V.B and M.P.; analysis and interpretation of the data: V.B., M.R.M., F.F., E.C., G.B., E.M., M.B., A.S., and M.P.; the drafting of the paper or revising it critically for intellectual content: V.B., M.R.M., M.B., A.S., and M.P.; final approval of the version to be published: V.B., M.R.M., F.F., E.C., G.B., E.M., M.B., A.S., and M.P. All authors agree to be accountable for all aspects of the work.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [M.R.M.], upon reasonable request.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.