Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients
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Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients. / Knaak, Cornelia; Schuster, Friederike S; Nyvlt, Peter; Heeren, Patrick; Spies, Claudia; Schenk, Thomas; La Rosée, Paul; Janka, Gritta; Brunkhorst, Frank M; Lachmann, Gunnar.
in: PLOS ONE, Jahrgang 16, Nr. 7, e0254345, 2021.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients
AU - Knaak, Cornelia
AU - Schuster, Friederike S
AU - Nyvlt, Peter
AU - Heeren, Patrick
AU - Spies, Claudia
AU - Schenk, Thomas
AU - La Rosée, Paul
AU - Janka, Gritta
AU - Brunkhorst, Frank M
AU - Lachmann, Gunnar
PY - 2021
Y1 - 2021
N2 - BACKGROUND: 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.METHODS: This is a post-hoc analysis of a retrospective observational study including patients aged ≥ 18 years who were admitted to at least one adult ICU between January 2006 and August 2018 with hyperferritinemia ≥ 500 μg/L and of ≥ 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.RESULTS: 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.CONCLUSIONS: 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.TRIAL REGISTRATION: The study was registered with www.ClinicalTrials.gov (NCT02854943) on August 1, 2016.
AB - BACKGROUND: 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.METHODS: This is a post-hoc analysis of a retrospective observational study including patients aged ≥ 18 years who were admitted to at least one adult ICU between January 2006 and August 2018 with hyperferritinemia ≥ 500 μg/L and of ≥ 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.RESULTS: 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.CONCLUSIONS: 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.TRIAL REGISTRATION: The study was registered with www.ClinicalTrials.gov (NCT02854943) on August 1, 2016.
KW - Adult
KW - Aged
KW - Blood Transfusion
KW - Critical Illness/therapy
KW - Extracorporeal Membrane Oxygenation
KW - Female
KW - Ferritins/blood
KW - Hospital Mortality
KW - Humans
KW - Hyperferritinemia/blood
KW - Linear Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Renal Dialysis
U2 - 10.1371/journal.pone.0254345
DO - 10.1371/journal.pone.0254345
M3 - SCORING: Journal article
C2 - 34252125
VL - 16
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 7
M1 - e0254345
ER -