Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Am J Hematol. 2011 Sep;86(9):733-7. doi: 10.1002/ajh.22082. Epub 2011 Jul 28.
Iron overload is associated with significant morbidity and mortality yet is easily treated. The objective of this study was to create a tool that could be easily adapted to clinical practice that indicates the likelihood of a patient having undetected iron overload. We used the National Health and Nutrition Examination Survey (NHANES) 1999-2002 for US adults aged 20 years and older to build a model (unweighted n=8,779). We chose potential variables for inclusion that could be gathered by self-report or measured without laboratory data and were suggested by past literature on hemochromatosis and iron overload. We computed logistic regressions to create the scores by initially evaluating the variables' relationship with elevated ferritin and elevated transferrin saturation and then using odds ratios to correspond to scores. The resulting score on the IRon Overload ScreeNing Tool (IRON) was then validated with data on 13,844 adults in the NHANES III, 1988-94. Predictors in the final tool were age, gender, previous diagnoses of liver condition, osteoporosis or thyroid disease. The IRON score yielded an area under the curve (AUC) in the NHANES 1999-02 of 0.720 and an AUC of 0.685 in the NHANES III validation sample. The IRON score is a tool to assist in identification of patients with iron overload that has several qualities that make it attractive for use in clinical practice with an undifferentiated patient population including brevity, easily collected information and predictive ability comparable to other tools that help in directing screening.
铁过载与重大发病率和死亡率相关，但很容易治疗。本研究的目的是创建一个易于适应临床实践的工具，以指示患者是否存在未被发现的铁过载。我们使用了 1999-2002 年美国年龄在 20 岁及以上的成年人国家健康和营养调查（NHANES）来建立模型（未加权 n=8779）。我们选择了可能包含在内的潜在变量，这些变量可以通过自我报告或无需实验室数据测量获得，并且是过去关于血色病和铁过载的文献所建议的。我们通过最初评估变量与铁蛋白升高和转铁蛋白饱和度升高的关系，然后使用比值比对应分数，计算逻辑回归来创建分数。然后，使用 1988-94 年 NHANES III 中 13844 名成年人的数据验证 IRon 过载 ScreeNing 工具（IRON）上的分数。最终工具中的预测因子是年龄、性别、以前的肝脏疾病、骨质疏松症或甲状腺疾病诊断。在 NHANES 1999-02 中，IRON 评分的曲线下面积（AUC）为 0.720，在 NHANES III 验证样本中的 AUC 为 0.685。IRON 评分是一种帮助识别铁过载患者的工具，具有几个使其在具有未分化患者人群的临床实践中具有吸引力的特征，包括简洁性、易于收集的信息和与其他有助于指导筛查的工具相当的预测能力。
