Journal Article

Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients

Schenk, Thomas, Spies, Claudia, Schuster, Friederike S., Knaak, Cornelia, Brunkhorst, Frank M., Lachmann, Gunnar, Nyvlt, Peter, Janka, Gritta, Heeren, Patrick, La Rosée, Paul

2021

Overview

Ferritin is the major iron storage protein and an acute phase reactant. Hyperferritinemia is frequently seen in the critically ill where it has been hypothesized that not only underlying conditions but also factors such as transfusions, hemodialysis and extracorporeal life support (ECLS) lead to hyperferritinemia. This study aims to investigate the influence of transfusions, hemodialysis, and ECLS on hyperferritinemia in a multidisciplinary ICU cohort. This is a post-hoc analysis of a retrospective observational study including patients aged [greater than or equal to] 18 years who were admitted to at least one adult ICU between January 2006 and August 2018 with hyperferritinemia [greater than or equal to] 500 [mu]g/L and of [greater than or equal to] 14 days between two ICU ferritin measurements. Patients with hemophagocytic lymphohistiocytosis (HLH) were excluded. To identify the influence of transfusions, hemodialysis, and ECLS on ferritin change, multivariable linear regression analysis with ferritin change between two measurements as dependent variable was performed. A total of 268 patients was analyzed. Median duration between measurements was 36 days (22-57). Over all patients, ferritin significantly increased between the first and last measurement (p = 0.006). Multivariable linear regression analysis showed no effect of transfusions, hemodialysis, or ECLS on ferritin change. Changes in aspartate aminotransferase (ASAT) and sequential organ failure assessment (SOFA) score were identified as influencing factors on ferritin change [unstandardized regression coefficient (B) = 2.6; (95% confidence interval (CI) 1.9, 3.3); p < 0.001 and B = 376.5; (95% CI 113.8, 639.1); p = 0.005, respectively]. Using the same model for subgroups of SOFA score, we found SOFA platelet count to be associated with ferritin change [B = 1729.3; (95% CI 466.8, 2991.9); p = 0.007]. No association of ferritin change and in-hospital mortality was seen in multivariable analysis. The present study demonstrates that transfusions, hemodialysis, and ECLS had no influence on ferritin increases in critically ill patients. Hyperferritinemia appears to be less the result of iatrogenic influences in the ICU thereby underscoring its unskewed diagnostic value.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Anesthesiology / Aspartate aminotransferase / Biology and Life Sciences / Blood / Blood diseases / Blood oxygenation, Extracorporeal / Blood transfusion / Care and treatment / Complications and side effects / Confidence intervals / Critically ill / Dependent variables / Extracorporeal membrane oxygenation / Ferritin / Health aspects / Hematology / Hemodialysis / Histiocytosis / Intensive care / Iron / Laboratories / Lymphocytosis / Medicine / Medicine and Health Sciences / Mortality / Observational studies / Patients / Pediatrics / Physical Sciences / Regression analysis / Regression coefficients / Research and Analysis Methods / Risk factors / Sensitivity analysis / Sepsis / Statistical analysis / Subgroups