Vasques-Nóvoa Francisco, Pimentel Maria João, Marques Pedro, Vale Catarina, Gomes Filipa, Neves João Sérgio, Barroso Isaac, Guimarães João Tiago, Bettencourt Paulo, Leite-Moreira Adelino F, Roncon-Albuquerque Roberto, Almeida Jorge, Ferreira João Pedro, Friões Fernando
Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal.
Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.
Clin Res Cardiol. 2024 Sep 19. doi: 10.1007/s00392-024-02535-x.
Ferritin is commonly used to evaluate iron stores and guide therapeutic decisions regarding intravenous iron supplementation. However, in the context of AHF, inflammation-driven upregulation of ferritin might disrupt its correlation with iron stores, restricting iron bioavailability and potentially amplifying the inflammatory response.
This study aims to assess the clinical and prognostic associations of ferritin levels in an AHF cohort and to determine whether the prognostic value of ferritin is influenced by the presence of infection, inflammatory activation, and other markers of iron deficiency.
The association between ferritin and clinical outcomes (180 days) in AHF was evaluated in a cohort of 526 patients from the EDIFICA registry.
The median ferritin plasma concentration at admission was 180 pg/mL. Patients with higher ferritin levels at admission were predominantly men, exhibiting a high prevalence of chronic kidney disease and alcohol consumption, and presenting with lower blood pressure and a higher incidence of clinical infection. Higher ferritin levels were associated with increased risk of the composite of heart failure hospitalization or cardiovascular death (Tertile 2: HR 1.75; 95% CI 1.10-2.79; p = 0.017; Tertile 3: HR 1.79; 95% CI 1.08-2.97; p = 0.025), independently of classical HF prognostic factors, inflammatory and iron-related markers. No significant associations were found between admission serum iron or transferrin saturation tertiles, iron status categories, or guideline-defined iron deficiency (ID) criteria and the primary composite outcome. However, at discharge, patients who met the criteria for defective iron utilization, low iron storage, or guideline-defined ID had a lower risk of the composite endpoint compared to those with normal iron utilization or who did not meet the guideline-defined ID criteria, respectively.
Elevated ferritin levels are independently associated with poor prognosis in AHF. Low ferritin levels are associated with a favorable outcome and do not carry significant value in identifying ID in this population.
铁蛋白常用于评估铁储备，并指导关于静脉补铁治疗的决策。然而，在急性心力衰竭（AHF）的情况下，炎症驱动的铁蛋白上调可能会破坏其与铁储备的相关性，限制铁的生物利用度，并可能放大炎症反应。
本研究旨在评估AHF队列中铁蛋白水平的临床和预后相关性，并确定铁蛋白的预后价值是否受感染、炎症激活及其他缺铁标志物的影响。
在EDIFICA注册研究的526例患者队列中，评估铁蛋白与AHF临床结局（180天）之间的关联。
入院时铁蛋白血浆浓度中位数为180 pg/mL。入院时铁蛋白水平较高的患者主要为男性，慢性肾脏病和饮酒患病率高，血压较低，临床感染发生率较高。较高的铁蛋白水平与心力衰竭住院或心血管死亡复合终点风险增加相关（第二三分位数：HR 1.75；95%CI 1.10 - 2.79；p = 0.017；第三三分位数：HR 1.79；95%CI 1.08 - 2.97；p = 0.025），独立于经典的心力衰竭预后因素、炎症和铁相关标志物。入院时血清铁或转铁蛋白饱和度三分位数、铁状态类别或指南定义的缺铁（ID）标准与主要复合结局之间未发现显著关联。然而，出院时，符合铁利用缺陷、铁储备低或指南定义的ID标准的患者与铁利用正常或不符合指南定义的ID标准的患者相比，复合终点风险较低。
铁蛋白水平升高与AHF预后不良独立相关。低铁蛋白水平与良好结局相关，在该人群中识别ID无显著价值。
