Department of General Surgery, Guglielmo da Saliceto Hospital, Piacenza, Italy.
World J Emerg Surg. 2021 Mar 8;16(1):9. doi: 10.1186/s13017-021-00354-3.
SARS-CoV-2 infection has spread worldwide, and the pathogenic mechanism is still under investigation. The presence of a huge inflammatory response, defined as "cytokine storm," is being studied in order to understand what might be the prognostic factors implicated in the progression of the infection, with ferritin being one of such markers. The role of ferritin as a marker of inflammation is already known, and whether it changes differently between COVID and non-COVID patients still remains unclear. The aim of this retrospective analysis is to understand whether the inflammatory process in these two types is different.
In this retrospective analysis, we compared 17 patients affected by SARS-CoV-2, who had been admitted between February and April 2020 (group A) along with 30 patients admitted for acute surgical disease with SARS-CoV-2 negative swab (group B). A further subgroup of Covid negative patients with leukocytosis was compared to group A.
In group A, the median (interquartile range) serum ferritin was 674 (1284) ng/mL, and it was double the cutoff (300 ng/mL) in 9 out of 17 (52%). The median (IQR) value of ferritin level in the total blood samples of group B was 231, and in the subgroup with leucocytosis, 149 (145). Group A showed a significantly higher ferritin median level compared to the entire group B (two-tailed Mann-Whitney test, p < 0.0001) as well as to the subgroup with leucocytosis (p < 0.0014).
The role of iron metabolism appears to be directly involved in COVID infection. On the other hand, in the acute inflammation of patients admitted for surgery, and probably in other common phlogistic processes, iron modifications appear to be self-limited. However, our finding suggests the use of ferritin as a marker for COVID infection.
SARS-CoV-2 感染已在全球范围内传播，其发病机制仍在研究中。目前正在研究一种巨大的炎症反应，即所谓的“细胞因子风暴”，以便了解哪些可能是感染进展中涉及的预后因素，铁蛋白就是其中的一个标志物。铁蛋白作为炎症标志物的作用已经为人所知，但它在 COVID 和非 COVID 患者中的变化是否不同仍不清楚。本回顾性分析旨在了解这两种类型的炎症过程是否不同。
在这项回顾性分析中，我们比较了 2020 年 2 月至 4 月期间收治的 17 例 SARS-CoV-2 感染患者（A 组）和 30 例 SARS-CoV-2 拭子阴性的急性外科疾病患者（B 组）。我们还将白细胞增多的 COVID 阴性患者与 A 组进行了比较。
A 组患者血清铁蛋白中位数（四分位距）为 674（1284）ng/ml，有 9 例（52%）超过 300ng/ml 的截断值。B 组患者的全血铁蛋白中位值（四分位距）为 231，白细胞增多亚组为 149（145）。A 组的铁蛋白中位数水平明显高于整个 B 组（双侧曼-惠特尼检验，p<0.0001）和白细胞增多亚组（p<0.0014）。
铁代谢的作用似乎直接参与了 COVID 感染。另一方面，在接受手术治疗的患者的急性炎症中，铁的改变可能是自限性的，而且可能在其他常见的炎症过程中也是如此。然而，我们的发现提示可以将铁蛋白作为 COVID 感染的标志物。
