OBJECTIVE: Because iron is both an essential and toxic micronutrient influencing the development of microbial infections, we evaluated the usefulness of iron parameters as outcome predictors in ICU patients. DESIGN: Prospective clinical single-center non-interventional study. SETTING: General internal medicine ICU; German University hospital. PATIENTS: One hundred and twelve septic and 43 nonseptic ICU patients, 156 healthy blood donors. MEASUREMENTS AND MAIN RESULTS: Serum iron parameters at admission were correlated with short and long term mortality in ICU subjects. Both hepcidin and ferritin concentrations were significantly elevated in ICU patients compared with blood donors and were the highest in septic patients. On the contrary, serum iron and transferrin levels were decreased in ICU subjects with lowest values among septic patients. Hepcidin values correlated with ferritin levels, and serum iron correlated strongly with transferrin saturation. A moderate correlation of hepcidin, ferritin, and transferrin with inflammatory parameters was noted. Both short- and long-term survivors displayed higher ferritin/transferrin levels and lower transferrin saturation. In Kaplan-Meier analyses, low iron levels (cutoff 10.5 μmol/mL), low transferrin saturation (cutoff 55%), and high serum transferrin concentrations (cutoff 1.6 g/L) were associated with short- and long-term survival. In the subgroup of septic ICU subjects, low iron levels and transferrin saturation went along with a nonlethal outcome. CONCLUSIONS: Our findings demonstrate that parameters of iron metabolism, particularly transferrin saturation, that reflect serum iron availability, are strong outcome predictors in ICU patients. These data suggest that a failure of iron homeostasis with increased iron availability in serum occurs in lethally ill ICU patients and should trigger prospective clinical trials evaluating the usefulness of iron-chelating therapy in critical illness and sepsis.
OBJECTIVE: Because iron is both an essential and toxic micronutrient influencing the development of microbial infections, we evaluated the usefulness of iron parameters as outcome predictors in ICU patients. DESIGN: Prospective clinical single-center non-interventional study. SETTING: General internal medicine ICU; German University hospital. PATIENTS: One hundred and twelve septic and 43 nonseptic ICU patients, 156 healthy blood donors. MEASUREMENTS AND MAIN RESULTS: Serum iron parameters at admission were correlated with short and long term mortality in ICU subjects. Both hepcidin and ferritin concentrations were significantly elevated in ICU patients compared with blood donors and were the highest in septic patients. On the contrary, serum iron and transferrin levels were decreased in ICU subjects with lowest values among septic patients. Hepcidin values correlated with ferritin levels, and serum iron correlated strongly with transferrin saturation. A moderate correlation of hepcidin, ferritin, and transferrin with inflammatory parameters was noted. Both short- and long-term survivors displayed higher ferritin/transferrin levels and lower transferrin saturation. In Kaplan-Meier analyses, low iron levels (cutoff 10.5 μmol/mL), low transferrin saturation (cutoff 55%), and high serum transferrin concentrations (cutoff 1.6 g/L) were associated with short- and long-term survival. In the subgroup of septic ICU subjects, low iron levels and transferrin saturation went along with a nonlethal outcome. CONCLUSIONS: Our findings demonstrate that parameters of iron metabolism, particularly transferrin saturation, that reflect serum iron availability, are strong outcome predictors in ICU patients. These data suggest that a failure of iron homeostasis with increased iron availability in serum occurs in lethally ill ICUpatients and should trigger prospective clinical trials evaluating the usefulness of iron-chelating therapy in critical illness and sepsis.
Authors: Pryscila Miranda; Leonardo Gil-Santana; Marina G Oliveira; Eliene D D Mesquita; Elisangela Silva; Anneloek Rauwerdink; Frank Cobelens; Martha M Oliveira; Bruno B Andrade; Afrânio Kritski Journal: PLoS One Date: 2017-04-06 Impact factor: 3.240
Authors: André Viveiros; Armin Finkenstedt; Benedikt Schaefer; Mattias Mandorfer; Bernhard Scheiner; Konrad Lehner; Moritz Tobiasch; Thomas Reiberger; Herbert Tilg; Michael Edlinger; Heinz Zoller Journal: Liver Transpl Date: 2018-03 Impact factor: 5.799
Authors: Edward Litton; Stuart Baker; Wendy Erber; Shannon Farmer; Janet Ferrier; Craig French; Joel Gummer; David Hawkins; Alisa Higgins; Axel Hofmann; Bart De Keulenaer; Julie McMorrow; John K Olynyk; Toby Richards; Simon Towler; Robert Trengove; Steve Webb Journal: J Intensive Care Date: 2018-09-10
Authors: Margit Boshuizen; Jan M Binnekade; Benjamin Nota; Kirsten van de Groep; Olaf L Cremer; Pieter R Tuinman; Janneke Horn; Marcus J Schultz; Robin van Bruggen; Nicole P Juffermans Journal: Ann Intensive Care Date: 2018-05-02 Impact factor: 6.925