A Lalueza1, B Ayuso2, E Arrieta2, H Trujillo2, D Folgueira3, C Cueto4, A Serrano5, J Laureiro2, C Arévalo-Cañas2, C Castillo2, C Díaz-Pedroche6, C Lumbreras7. 1. Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain; Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain. Electronic address: lalueza@hotmail.com. 2. Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain. 3. Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain; Department of Microbiology, School of Medicine, Complutense University, Madrid, Spain. 4. Department of Biochemistry, University Hospital 12 de Octubre, Madrid, Spain. 5. Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain. 6. Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain. 7. Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain; Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain; Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain.
Abstract
OBJECTIVES: There is increasing evidence that ferritin is a key marker of macrophage activation, but its potential role in influenza infection remains unexplored. Our aim was to assess whether hyperferritinaemia (ferritin ≥500 ng/mL) could be a marker of poor prognosis in hospitalized patients with confirmed influenza A infection. METHODS: We prospectively recruited all hospitalized adult patients who tested positive for the influenza A rRT-PCR assay performed on respiratory samples in two consecutive influenza periods (2016-17 and 2017-18). Poor outcome was defined as the presence of at least one of the following: respiratory failure, admission to the intensive care unit, or in-hospital mortality. RESULTS: Among 494 patients, 68 (14%) developed poor outcomes; 112 patients (23%) had hyperferritinaemia (39/68, 57% in the poor-outcome group versus 73/426, 17% in the remaining patients, p < 0.0001). Median serum ferritin levels were significantly higher in the subgroup of patients with poor outcomes (609 ng/mL, range 231-967 versus 217 ng/mL, range 140-394, p < 0.0001). In multivariate analysis, hyperferritinaemia was associated with a five-fold increase in the odds ratio of developing poor outcome. After adjusting for classic influenza risk factors, ferritin remained as a significant predictive factor in all exploratory models. Ferritin levels had a good discriminative capacity with an area under the ROC curve of 0.72 (95% confidence interval (CI) 0.65-0.8, p < 0.001) and an overall diagnostic accuracy for predicting poor outcome of 79.3% (95%CI 75.4-82.7%). CONCLUSIONS: Serum ferritin may discriminate a subgroup of patients with influenza infection who have a higher risk of developing a poor outcome.
OBJECTIVES: There is increasing evidence that ferritin is a key marker of macrophage activation, but its potential role in influenza infection remains unexplored. Our aim was to assess whether hyperferritinaemia (ferritin ≥500 ng/mL) could be a marker of poor prognosis in hospitalized patients with confirmed influenza A infection. METHODS: We prospectively recruited all hospitalized adult patients who tested positive for the influenza A rRT-PCR assay performed on respiratory samples in two consecutive influenza periods (2016-17 and 2017-18). Poor outcome was defined as the presence of at least one of the following: respiratory failure, admission to the intensive care unit, or in-hospital mortality. RESULTS: Among 494 patients, 68 (14%) developed poor outcomes; 112 patients (23%) had hyperferritinaemia (39/68, 57% in the poor-outcome group versus 73/426, 17% in the remaining patients, p < 0.0001). Median serum ferritin levels were significantly higher in the subgroup of patients with poor outcomes (609 ng/mL, range 231-967 versus 217 ng/mL, range 140-394, p < 0.0001). In multivariate analysis, hyperferritinaemia was associated with a five-fold increase in the odds ratio of developing poor outcome. After adjusting for classic influenza risk factors, ferritin remained as a significant predictive factor in all exploratory models. Ferritin levels had a good discriminative capacity with an area under the ROC curve of 0.72 (95% confidence interval (CI) 0.65-0.8, p < 0.001) and an overall diagnostic accuracy for predicting poor outcome of 79.3% (95%CI 75.4-82.7%). CONCLUSIONS: Serum ferritin may discriminate a subgroup of patients with influenza infection who have a higher risk of developing a poor outcome.
Authors: Ali A Ghweil; Mohammed H Hassan; Ashraf Khodeary; Ahmed Okasha Mohamed; Haggagy Mansour Mohammed; Ahmed Alyan Abdelazez; Heba Ahmed Osman; Shamardan Ezzeldin S Bazeed Journal: Infect Drug Resist Date: 2020-07-17 Impact factor: 4.003
Authors: Amal A Gharamti; Fei Mei; Katherine C Jankousky; Jin Huang; Peter Hyson; Daniel B Chastain; Jiawei Fan; Sharmon Osae; Wayne W Zhang; José G Montoya; Kristine M Erlandson; Sias J Scherger; Carlos Franco-Paredes; Andrés F Henao-Martínez; Leland Shapiro Journal: Open Forum Infect Dis Date: 2021-03-14 Impact factor: 3.835