优化的血清铁蛋白预测输血依赖型地中海贫血中的铁过载：似然比和年龄调整方法。

Optimized serum ferritin prediction of iron overload in transfusion-dependent thalassemia: likelihood ratio and age-adjustment approach.

机构信息

From the Department of Radiology, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates.

From the Radiography and Medical Imaging Department, Fatima College of Health Sciences, Al Ain, Abu Dhabi, United Arab Emirates.

出版信息

Ann Saudi Med. 2023 Mar-Apr;43(2):90-96. doi: 10.5144/0256-4947.2023.90. Epub 2023 Apr 6.

DOI:10.5144/0256-4947.2023.90

PMID:37031371

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10082945/

Abstract

BACKGROUND

Early detection of iron overload in transfusion-dependent thalassemia (TDT) patients is critical to prevent complications and improve survival.

OBJECTIVES

Evaluate the utility of serum ferritin (SF) in the prediction of hepatic and myocardial iron overload (HIO and MIO) compared to T2*-MRI.

DESIGN

Retrospective SETTINGS: Governmental hospitals.

PATIENTS AND METHODS

Patients with TDT who had T2*-MRI examinations between January 2016 to October 2019 were included. The predictive value of SF for detection of HIO and MIO was assessed by measuring area under the curve (AUC). A sample size of 123 cases was calculated to detect a correlation of 0.25 with 90% power and a two-sided type I error of 0.05.

MAIN OUTCOME MEASURES

The correlation between SF and estimated hepatic iron concentration.

SAMPLE SIZE

137 TDT patients who required regular blood transfusions.

RESULTS

The predictive value of SF was excellent for detection of HIO (AUC=0.83-0.87) but fair for detection of MIO (AUC=0.67). The two independent predictors of MIO were age and SF. The log of (age × SF) enhanced the SF predictive value for MIO (AUC=0.78). SF values of 700 and 1250 mg/L effectively excluded mild and moderate HIO with a sensitivity of 97.8% and 94.2%, respectively (LR-=0.1). While SF values of 1640 and 2150 mg/L accurately diagnosed mild and moderate HIO with a specificity of 95.55% and 96.4%, respectively (LR+>10). A log of (age × SF) cut-off value of 4.15 effectively excluded MIO (LR-=0.1), while a value of 4.65 moderately confirmed MIO (LR+=3.2).

CONCLUSIONS

SF is an excellent predictor of hepatic IO in TDT. Age adjustment enhanced its myocardial IO predictive accuracy. Likelihood ratio-based SF cut-off values may help clinicians in risk stratification and treatment decision-making.

LIMITATIONS

The laboratory data were gathered retrospectively and although the risk of selection bias for T2*-MRI examination is thought to be low, it cannot be ignored.

CONFLICT OF INTEREST

None.

摘要

背景

早期发现依赖输血的地中海贫血（TDT）患者的铁过载对于预防并发症和提高生存率至关重要。

目的

评估血清铁蛋白（SF）在预测肝脏和心肌铁过载（HIO 和 MIO）方面的效用，与 T2*-MRI 相比。

设计

回顾性设置：政府医院。

患者和方法

纳入 2016 年 1 月至 2019 年 10 月期间接受 T2*-MRI 检查的 TDT 患者。通过测量曲线下面积（AUC）评估 SF 对 HIO 和 MIO 检测的预测价值。计算了 123 例样本量，以检测 0.25 的相关性，具有 90%的功率和双侧 I 型错误 0.05。

主要观察指标

SF 与估计肝铁浓度之间的相关性。

样本量

137 例需要定期输血的 TDT 患者。

结果

SF 对 HIO 的检测具有出色的预测价值（AUC=0.83-0.87），但对 MIO 的检测则为适度（AUC=0.67）。MIO 的两个独立预测因子是年龄和 SF。（年龄×SF）的对数增强了 SF 对 MIO 的预测价值（AUC=0.78）。SF 值为 700 和 1250 mg/L 可有效地排除轻度和中度 HIO，其灵敏度分别为 97.8%和 94.2%（LR-=0.1）。而 SF 值为 1640 和 2150 mg/L 可准确诊断轻度和中度 HIO，特异性分别为 95.55%和 96.4%（LR+>10）。（年龄×SF）对数截断值为 4.15 可有效地排除 MIO（LR-=0.1），而 4.65 值则适度确认 MIO（LR+=3.2）。