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Evaluation of ferritin and the ferritin index as prognostic biomarkers in septic shock

  • Chandrasekaran Gunasekaran
    Affiliations
    Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia

    Department of Intensive Care, Ballarat Base Hospital, Victoria, Australia

    Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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  • Glenn M. Eastwood
    Affiliations
    Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
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  • Leah Peck
    Affiliations
    Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
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  • Helen Young
    Affiliations
    Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
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  • Ary Serpa Neto
    Affiliations
    Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia

    Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

    Department of Intensive Care, Albert Einstein Medical Center, Sao Paolo, Brazil
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  • Rinaldo Bellomo
    Correspondence
    Corresponding author. Department of Intensive Care Medicine, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, 3084, Australia. Tel.: +613 9496 5992; Fax: +613 9496 3932.
    Affiliations
    Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia

    Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia

    Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

    Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia

    Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Australia
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Published:December 02, 2022DOI:https://doi.org/10.1016/j.aucc.2022.10.012

      Abstract

      Background

      Ferritin, an acute phase reactant, and the ferritin index (FI = observed ferritin level/upper limit of normal level for age and sex) may be prognostic biomarkers in septic shock and cardiac surgery patients.

      Objective

      The purpose of this exploratory study is to assess the outcome associations of ferritin and FI levels in septic shock compared to post–cardiac surgery patients.

      Design

      This was a prospective, double-centre, observational study.

      Setting

      The study setting involved two adult intensive care units (ICUs) in Victoria, Australia.

      Participants

      Sixty-one septic shock and 30 post–cardiac surgery patients participated in this study.

      Main outcome measures

      We measured ferritin and FI on ICU admission (T1) and 24 h later (T2) to assess its correlation with mortality, illness severity, and hospital length of stay (LOS).

      Results

      The baseline characteristics of patients in the septic shock group and cardiac surgery group were similar apart from illness severity scores (APACHE III and modified SOFA score). Septic shock patients had more physiological derangements as well as greater use and higher doses of norepinephrine at both T1 and T2. Septic shock patients had significantly higher median ferritin levels (372 μg/L versus 198 μg/L; p < 0.001 at T1, 457 μg/L versus 264 μg/L; p = 0.001 at T2) than post–cardiac surgery patients. Ferritin levels, however, did not have a linear correlation with illness severity or hospital mortality. Instead, there was an association between high ferritin levels at T2 and longer ICU (p = 0.017) and hospital LOS (p = 0.013). Females with septic shock had significantly higher FI (p < 0.001 at T1, p = 0.004 at T2) than males.

      Conclusion

      In septic shock patients, ferritin levels and FI were twice the level compared to post-cardiac surgery patients. Both had no association with mortality, but levels above the median at 24 h were associated with longer ICU and hospital LOS.

      Keywords

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