Đánh giá nồng độ ferritin, D-dimer và độ nặng ở bệnh nhân Covid-19

TÓM TẮT Đặt vấn đề: Việc điều trị bệnh nhân COVID-19 đặc biệt là những bệnh nhân nặng và nguy kịch vẫn là thách thức đối với nền y tế còn hạn chế trong bối cảnh hiện nay của nước ta. Vì vậy, việc dựa vào các dấu hiệu lâm sàng và các xét nghiệm sẵn có để đánh giá mức độ nặng và khả năng tiến triển nặng của bệnh là rất cần thiết để có hướng tiếp cận kịp thời. Trong đó ferritin và d-dimer được cho là các chỉ dấu sinh học có liên quan đến mức độ nặng của bệnh COVID 19. Nghiên cứu này nhằm: (1) Đánh giá tình trạng tăng nồng độ ferritin và nồng độ d-dimer huyết tương ở bệnh nhân COVID-19. (2) Xác định giá trị điểm cắt nồng độ d-dimer huyết tương nhằm tiên đoán mức độ nặng của bệnh nhân COVID-19. Phương pháp: Nghiên cứu mô tả cắt ngang trên 209 bệnh nhân mắc COVID-19 điều trị tại Trung tâm hồi sức tích cực người bệnh COVID-19 trực thuộc bệnh viện trung ương Huế tại thành phố Hồ Chí Minh từ tháng 08/2021 đến tháng 11/2019. Tất cả bệnh nhân được đánh giá mức độ nặng của bệnh COVID-19 dựa vào triệu chứng lâm sàng và độ bão hòa oxy máu, được tiến hành định lượng nồng độ ferritin và d-dimer. Tăng nồng độ ferritin được định nghĩa: ở nam là từ 400ng/ml trở lên và ở nữ là từ 150ng/ml trở lên, tăng nồng độ d-dimer là từ 500 ng/ml trở lên. Xử lý số liệu bằng phần mềm SPSS 16.0. Kết quả: Tỉ lệ tăng ferritin ở nhóm bệnh nhân nặng là 89,77%. Nồng độ d-dimer ở nhóm bệnh nhân nặng trung bình là 4732,43ng/ml. Khi nồng độ d-dimer > 1537ng/ml thì sẽ có nguy cơ là bệnh COVID-19 sẽ nặng với diện tích dưới đường cong (AUC) 0,699 (khoảng tin cậy 95%: 0,627 - 0,771); độ nhạy 57,95% và độ đặc hiệu 75,83%; p < 0,0001. Kết luận: Ferritin và d-dimer huyết tương là yếu tố liên quan độc lập với độ nặng của bệnh COVID-19. ABSTRACT EVALUATION OF THE PLASMA CONCENTRATIONS OF FERRITIN, D - DIMER AND SEVERITY IN COVID-19 PATIENTS Background: The treatment of COVID-19 patients, especially the severely ill and critically ill, is still a challenge for the limited health sector in the current context of our country. Therefore, it is necessary to rely on clinical signs and available tests to assess the severity and possibility of severe progression of the disease to have a timely approach. Among them, ferritin and d-dimer are thought to be biomarkers related to the severity of COVID-19 disease. Therefore, this study aims to evaluate the increase in plasma ferritin concentration and the plasma concentrations of d-dimer in COVID-19 patients and to determine the cut-off of d-dimer to prognosis the severity in COVID-19 patients. Methods: A cross - sectional study was performed on 209 COVID-19 patients at COVID-19 Intensive Care Center ofHue Central Hospital in Ho Chi Minh city from August 2021 to November 2021. All patients were evaluated the severity of disease based on symptoms, signs, and saturation of oxygen in the blood and were measured plasma concentration of ferritin and d-dimer. The increase ferritin concentration is defined as higher than 400ng/ml in men and 150ng/ml in women; d-dimer was elevated when ≥ 500ng/ml. Data were analyzed by SPSS version 16.0. Results: In the severe patient group, the increase ferritin concentration accounted for 89.77%, the average concentration of d-dimer was 4732.43ng/ml. When the d-dimer concentration was more than 1537ng/ml, there was a risk that COVID-19 would be severe with the area under the curve (AUC) 0.699 (95% CI: 0.627 - 0.771); sensitivity 57.95% and specificity 75.83%; p < 0.0001. Conclusion: Plasma ferritin and d-dimer concentrations are independent risk factors for severity in COVID-19 patients. Key words: Ferritin, d-dimer, COVID-19 patients.

Serum Ferritin Concentration in Corona Virus Disease 19

Introduction: Coronavirus disease 19 (COVID-19) is a complex disease responsible for the development of exacerbated inflammatory response (cytokine storm) that ultimately leads to multiorgan failure and death. Serum ferritin has been recently identified as one of the inflammatory markers responsible for the pro-inflammatory effects. Small amount of ferritin is present in plasma (15-150 ng/mL) which might increase with the severity of COVID-19. Therefore, measurement of ferritin is essential in identifying disease severity and predict disease prognosis. Objective: This study aims to assess the ferritin level in COVID-19 patients. Methods: A cross-sectional study was carried out on 259 COVID-19 patients visiting KIST Medical College and Teaching Hospital (KISTMCTH), Lalitpur, Nepal from November 2020 to April 2021. Serum ferritin was estimated in the automated Siemens ADVIA Centaur CP Chemiluminescence Immunoassay system. All the patients visiting KISTMCTH referred by clinician for ferritin assessment were included in this study. Data collected using the proforma tool was tabulated in SPSS 21 and statistical analysis was done by inferential statistical test. Results: Out of total 259 COVID-19 patients, 58.7% were male and the majority of patients (82.6%) were below 70 years of age. The mean age for all participants was 52.11±16.59 years. Hyperferritinemia was seen in 218 (84.16%) COVID -19 patients. The mean value of serum ferritin was 767.1±789.86 (IQR: 12.8-4590) ng/mL and was significantly higher in males (p<0.001). Comparing the mean values of ferritin between the patients below and above 70 years, no statistical difference was observed (p=0.872). Conclusions: In our study, serum ferritin levels were greatly increased in patients with COVID-19 infection. Keywords: Coronavirus disease 19; cytokine storm; inflammatory marker; serum ferritin.

Iron deficiency and internalizing symptom severity in unmedicated adolescents: a pilot study

Background Iron plays a key role in a broad set of metabolic processes. Iron deficiency is the most common nutritional deficiency in the world, but its neuropsychiatric implications in adolescents have not been examined. Methods Twelve- to 17-year-old unmedicated females with major depressive or anxiety disorders or with no psychopathology underwent a comprehensive psychiatric assessment for this pilot study. A T1-weighted magnetic resonance imaging scan was obtained, segmented using Freesurfer. Serum ferritin concentration (sF) was measured. Correlational analyses examined the association between body iron stores, psychiatric symptom severity, and basal ganglia volumes, accounting for confounding variables. Results Forty females were enrolled, 73% having a major depressive and/or anxiety disorder, 35% with sF < 15 ng/mL, and 50% with sF < 20 ng/mL. Serum ferritin was inversely correlated with both anxiety and depressive symptom severity (r = −0.34, p < 0.04 and r = −0.30, p < 0.06, respectively). Participants with sF < 15 ng/mL exhibited more severe depressive and anxiety symptoms as did those with sF < 20 ng/mL. Moreover, after adjusting for age and total intracranial volume, sF was inversely associated with left caudate (Spearman's r = −0.46, p < 0.04), left putamen (r = −0.58, p < 0.005), and right putamen (r = −0.53, p < 0.01) volume. Conclusions Brain iron may become depleted at a sF concentration higher than the established threshold to diagnose iron deficiency (i.e. 15 ng/mL), potentially disrupting brain maturation and contributing to the emergence of internalizing disorders in adolescents.

Micronutrient deficiency in menstrual dysfunction among women of reproductive age

Objective. To determine whether inorganic menstrual dysfunction (MD) is associated with magnesium, iron and vitamin D deficiency in women of reproductive age. Materials and methods. The study group I consisted of 50 women with MD: dysmenorrhea (16 women), oligomenorrhea (12 women), functional hypothalamic amenorrhea (3 patients) and acyclic abnormal uterine bleeding (19 women), the comparison group II was composed of 30 patients with normal menstrual function. The methods of study included history taking using a questionnaire to detect the signs of magnesium deficiency, physical examination, echography of pelvic organs, full blood count, blood tests to determine the concentration of magnesium, vitamin D and ferritin as well as consulting a therapeutist. Results. Magnesium deficiency was registered significantly more often in patients with MD (93.0 3.6 %, 73.0 8.1 %, respectively; p 0.05). The most typical signs of magnesium deficiency were the central symptoms: headache (58.0 7.1 %, 22.0 7.6 %; p 0.001), irritability (53.0 7.1 %, 26.0 8.0 %; p 0.01), dyssomnia (45.0 7.0 %, 17.0 6.9 %; p 0.01), dizziness (42.5 7.0 %, 22.0 7.6 %; p 0.05), a decrease in libido (34.0 6.7 %, 13.0 6.1 %; p 0.05), as well as trophic disturbances including hair loss (38.0 6.9 %, 13.0 6.9 %; p 0.01). Similar findings were obtained when we studied the iron supply: the frequency of latent iron deficiency (according to ferritin concentration) was 77.0 5.9 and 35.7 8.4 % respectively; p 0.001. Deficiency or insufficient supply of 25(ОH)D was registered significantly more often in women with MD in comparison with healthy women (45.0 7.0 %, 20.0 7.3 %; p 0.05). Conclusions. In summary, determination of the level of micronutrients and adequate compensation of their deficiency can be important factors in physiological correction of endocrine imbalance leading to functional disorders in the reproductive system and a decrease in fertility.

Coagulation profile and correlation between D-dimer, inflammatory markers, and COVID-19 severity in an Indonesian national referral hospital

Background Coagulopathy and inflammation are associated with coronavirus disease 2019 (COVID-19) severity. This study assessed D-dimer concentration and its correlation with inflammatory markers and COVID-19 severity. Methods This was a retrospective cross-sectional study involving 194 COVID-19 cases, with the severity of infection graded in accordance with the World Health Organization (WHO) guidelines. We measured D-dimer, C-reactive protein (CRP), and ferritin on admission and determined the cutoff values for D-dimer and CRP and evaluated the correlation between D-dimer and CRP and ferritin. Results Median D-dimer, CRP, and ferritin concentrations were 2240 µg/L, 73.2 mg/L, and 1173.8 µg/mL, respectively. The highest median D-dimer value was seen in mild and moderate acute respiratory distress syndrome (ARDS). The highest ferritin concentration was seen in severe ARDS. There was a significant correlation between D-dimer value and CRP (r = 0.327), but no significant correlation between D-dimer and ferritin (r = 0.101). The area under the receiver operating characteristic curve (AUC) for the combination of CRP ≥72.65 mg/L and D-dimer ≥1250 µg/L as a marker of COVID-19 severity was 0.722 (95% confidence interval (CI): 0.615–0.781). Conclusion The combination of CRP ≥72.65 mg/L and D-dimer ≥1250 µg/L can be used as marker of COVID-19 severity, with moderate accuracy.

EOSINOPHIL CATIONIC PROTEIN AND IRON STATUS IN PATIENTS INFECTED WITH Enterobius vermicularis

The primary goal of this study was to determine the function of eosinophil cationic protein in iron status in patients infected with Enterobius vermicularis. For this, a total of 583 suspected patients and thirty healthy people of the same age who have visited the AL-Zahra maternity and pediatrics laboratory, AL-Hakeem hospital, AL-Sajad hospital AL-Fruit al-Awsat hospital, and AL-Munadira hospital in AL-Najaf province from July 2020 to June 2021 were screened. The presence of E. vermicularis eggs was estimated by using the saline wet mount technique from faeces samples of all respondents. Blood samples were collected from the 60 positive and 30 healthy control group and centrifuged at 3000 rpm for 5 minutes to separate serum, which was then collected in sterile tubes. Each serum sample was divided into three parts and stored in the deep freezer at -20°C until the serological test was performed. The level of ECP, iron and ferritin in enterobiasis patients was estimated from the isolated blood serum. According to the Manufacturer Company instructions, the concentration of two biomarkers (ECP, Ferritin) in serum samples was determined using the ELISA technique (Human reader, Germany). While the concentration of iron was evaluated using a colourimetric method. In comparison to the control group, the concentration of ECP was reported significantly higher (P<0.05) in the E. vermiculris infected patients while the concentration of serum iron and ferritin was significantly decreased. The results of the current study can be concluded that E. vermicularis infection changes the serum ECP, iron, and ferritin concentration.

Iron Deficiency in Vegetarian and Omnivorous Individuals: Analysis of 1340 Individuals

The objective of this study was to evaluate the serum levels of ferritin and the prevalence of iron deficiency in vegan and omnivorous individuals by taking into account the presence of elements that cause an elevation of ferritin levels, such as increased homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), and high-sensitivity C-reactive protein (hs-CRP) values. The parameters were evaluated in 1340 individuals, i.e., 422 men and 225 women who do not menstruate and 693 women who do menstruate, based on omnivorous or vegetarian eating habits. The progressive increase in BMI, HOMA-IR, and inflammation caused an elevation in ferritin concentration, regardless of the eating habits in the groups studied. In the overall sample, omnivores had a higher prevalence of obesity, higher ferritin levels, and a lower prevalence of iron deficiency (ferritin < 30 ng/mL). However, after the exclusion of individuals with inflammation (with overweight/obesity and elevated hs-CRP levels), the actual iron deficiency was assessed and was not higher among vegetarians, except in women with regular menstrual cycles. Our data show that nutritional status and inflammation levels affect ferritin levels and may interfere with the correct diagnosis of iron deficiency in both vegetarian and omnivorous individuals. Compared to vegetarians, women who do not menstruate and men had the same prevalence of iron deficiency when following an omnivorous diet.

Iron deficiency in patients with cancer: a prospective cross-sectional study

BackgroundDespite the deleterious consequences of iron deficiency (ID) in patients with cancer, underdiagnosis is frequent. The CARENFER study aimed to assess the prevalence of ID using both serum ferritin concentration and transferrin coefficient saturation (iron-saturation of transferrin, TSAT) index, as well as ID anaemia in patients with cancer.MethodsThis prospective cross-sectional study was conducted in 15 oncology units in France in 2019. All patients present in the medical unit during the 2-week study period, regardless of the type of tumour (solid or haematological) and treatment, were eligible. Serum ferritin concentration, TSAT index and haemoglobin level were determined. ID and ID-associated anaemia were defined according to European Society of Medical Oncology 2018 Guidelines: ID was defined either as ferritin <100 µg/L (absolute ID) or as ferritin ≥100 µg/L and TSAT <20% (functional ID).ResultsA total of 1221 patients with different types of solid malignant tumours were analysed: median age 64 years; 89.4% under treatment for their cancer, mainly by chemotherapy (75.4%). Overall, ID was found in 57.9% (55.1–60.6) of patients. Among them, functional ID accounted for 64% of cases. ID anaemia was reported in 21.8% (19.6–24.2) of all patients with cancer. ID was highly prevalent in untreated (75/130, 57.4%) and non-anaemic (419/775, 54.1%) patients.ConclusionThis study highlights the high prevalence of ID in patients with cancer, whether or not associated with anaemia or treatment. These results emphasise the need to a better detection and management of ID in cancer, thereby optimising overall patient care.Trial registration numberClinicalTrials.gov Identifier: NCT03924271.