Ferritin, inflammation, and iron deficiency in acute heart failure: evidence from the EDIFICA cohort

Data de publicação: 01/01/2024 Data Ahead of Print: 19/09/2024

Autores da FMUP

Joaquim Adelino Correia Ferreira Leite Moreira

Autor
João Pedro Melo Marques Pinho Ferreira

Autor

Participantes de fora da FMUP

Vasques-Nóvoa F.
Pimentel M.J.
Marques P.
Vale C.
Gomes F.
Neves J.S.
Barroso I.
Guimarães J.T.
Bettencourt P.
Roncon-Albuquerque R.
Jr
Almeida J.
Friões F.

Unidades de investigação

Cirurgia e Fisiologia
Laboratório Associado RISE- Rede de Investigação em Saúde

Investigador

Fernando Carlos De Landér Schmitt
RISE-Health

Investigador

Fernando Carlos De Landér Schmitt

Abstract

Background: 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. Aim: 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. Methods: The association between ferritin and clinical outcomes (180 days) in AHF was evaluated in a cohort of 526 patients from the EDIFICA registry. Results: 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. Conclusions: 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. © The Author(s) 2024.

Dados da publicação

ISSN/ISSNe:: 1861-0692, 1861-0684
Tipo:: Article
Páginas:: -
DOI:: 10.1007/s00392-024-02535-x
Link para outro recurso:: www.scopus.com

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Vasques-Nóvoa F.:: 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, Porto, 4200-319, Portugal

Instituto de Investigação e Inovação em Saúde (I3S), University of Porto, Porto, Portugal
Pimentel M.J.:: Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, Porto, 4200-319, Portugal
Marques P.:: 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, Porto, 4200-319, Portugal
Vale C.:: 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, Porto, 4200-319, Portugal
Gomes F.:: 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, Porto, 4200-319, Portugal
Neves J.S.:: Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, Porto, 4200-319, Portugal

Department of Endocrinology, Centro Hospitalar Universitário de São João, Porto, Portugal
Barroso I.:: Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
Guimarães J.T.:: Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
Bettencourt P.:: 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, Porto, 4200-319, Portugal
Leite-Moreira A.F.:: Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, Porto, 4200-319, Portugal
Roncon-Albuquerque R.:: Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, Porto, 4200-319, Portugal
Jr:: Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, Porto, 4200-319, Portugal
Almeida J.:: 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, Porto, 4200-319, Portugal
Ferreira J.P.:: 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, Porto, 4200-319, Portugal

Université de Lorraine, Inserm, Centre d’Investigations Cliniques, Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
Friões F.:: 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, Porto, 4200-319, Portugal

Keywords

Acute heart failure; Ferritin; Inflammation; Iron deficiency

Campos de estudo

Financiamento

Fundação para a Ciência e a Tecnologia

Fundação para a Ciência e a Tecnologia ((UIDB/00051/2020)

Fundação para a Ciência e a Tecnologia (UIDP/00051/2020))