Fernández-Ruiz Mario, Parra Patricia, Ruiz-Merlo Tamara, López-Medrano Francisco, San Juan Rafael, Polanco Natalia, González Esther, Andrés Amado, Aguado José María
Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain.
Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain.
Transpl Infect Dis. 2018 Feb;20(1). doi: 10.1111/tid.12807. Epub 2018 Jan 10.
The liver-synthesized peptide hepcidin is a key regulator of iron metabolism and correlates with total iron stores. We analyzed the association between pre-transplant hepcidin-25 levels and infection after kidney transplantation (KT).
Serum hepcidin-25 levels were measured at baseline by high-sensitivity ELISA in 91 patients undergoing KT at our institution between December 2011 and March 2013. The impact of this biomarker on the incidence of post-transplant infection (excluding lower urinary tract infection) during the first year was assessed by Cox regression.
Mean hepcidin-25 level was 82.3 ± 67.4 ng/mL and strongly correlated with serum ferritin (Spearman's rho = 0.703; P < .001). There were no significant differences in hepcidin-25 levels between patients with or without overall infection (96.4 ± 67.5 vs 72.6 ± 66.7 ng/mL; P = .101). Such difference was evident for opportunistic (128.9 ± 75.0 vs 73.0 ± 62.3 ng/mL; P = .003) and, to a lesser extent, surgical-site infection (107.5 ± 73.3 vs 76.5 ± 65.2 ng/mL; P = .087). Patients with hepcidin-25 levels ≥72.5 ng/mL had higher 12-month cumulative incidence of overall infection (51.2% vs 29.2%; P = .032). After multivariate adjustment, hepcidin-25 ≥72.5 ng/mL acted as an independent risk factor for overall (adjusted hazard ratio [aHR] 3.86; 95% confidence interval [CI] 1.49-9.96; P = .005) and opportunistic infection (aHR 4.32; 95% CI 1.18-15.75; P = .027).
Elevated baseline serum hepcidin-25 levels were associated with increased risk of infection after KT, suggesting a role for iron overload in the individual susceptibility to post-transplant infection.
肝脏合成的肽类物质铁调素是铁代谢的关键调节因子，与铁的总储存量相关。我们分析了肾移植（KT）前铁调素-25水平与感染之间的关联。
2011年12月至2013年3月期间，在我们机构对91例接受KT的患者于基线时采用高灵敏度酶联免疫吸附测定法检测血清铁调素-25水平。通过Cox回归评估该生物标志物对移植后第一年感染（不包括下尿路感染）发生率的影响。
铁调素-25平均水平为82.3±67.4 ng/mL，与血清铁蛋白密切相关（Spearman相关系数=0.703；P<.001）。总体感染患者与未感染患者的铁调素-25水平无显著差异（96.4±67.5 vs 72.6±66.7 ng/mL；P=.101）。机会性感染患者与未感染患者的铁调素-25水平差异明显（128.9±75.0 vs 73.0±62.3 ng/mL；P=.003），手术部位感染患者与未感染患者的铁调素-25水平差异较小（107.5±73.3 vs 76.5±65.2 ng/mL；P=.087）。铁调素-25水平≥72.5 ng/mL的患者12个月总体感染累积发生率更高（51.2% vs 29.2%；P=.032）。多因素调整后，铁调素-25≥72.5 ng/mL是总体感染（调整后风险比[aHR] 3.86；95%置信区间[CI] 1.49 - 9.96；P=.005）和机会性感染（aHR 4.32；95% CI 1.18 - 15.75；P=.027）的独立危险因素。
基线血清铁调素-25水平升高与KT后感染风险增加相关，提示铁过载在个体对移植后感染的易感性中起作用。
