TY - JOUR
T1 - Iron metabolism in critically ill patients developing anemia of inflammation: a case control study
AU - Molecular Diagnosis and Risk Stratification of Sepsis (MARS) Consortium
AU - Boshuizen, Margit
AU - Binnekade, Jan M.
AU - Nota, Benjamin
AU - van de Groep, Kirsten
AU - Cremer, Olaf L.
AU - Tuinman, Pieter R.
AU - Horn, Janneke
AU - Schultz, Marcus J.
AU - van Bruggen, Robin
AU - Juffermans, Nicole P.
AU - de Beer, Friso M.
AU - Bos, Lieuwe D. J.
AU - Glas, Gerie J.
AU - van Hooijdonk, Roosmarijn T. M.
AU - Schouten, Laura R. A.
AU - Straat, Marleen
AU - Witteveen, Esther
AU - Wieske, Luuk
AU - Hoogendijk, Arie J.
AU - Huson, Mischa A.
AU - Scicluna, Brendon P.
AU - van der Poll, Tom
AU - van Vught, Lonneke A.
AU - Wiewel, Maryse A.
AU - Bonten, Marc J. M.
AU - Frencken, Jos F.
AU - Klein Klouwenberg, Peter M. C.
AU - Koster-Brouwer, Maria E.
AU - Ong, David S. Y.
AU - Verboom, Diana M.
PY - 2018
Y1 - 2018
N2 - Background: Anemia occurring as a result of inflammatory processes (anemia of inflammation, AI) has a high prevalence in critically ill patients. Knowledge on changes in iron metabolism during the course of AI is limited, hampering the development of strategies to counteract AI. This case control study aimed to investigate iron metabolism during the development of AI in critically ill patients. Methods: Iron metabolism in 30 patients who developed AI during ICU stay was compared with 30 septic patients with a high Hb and 30 non-septic patients with a high Hb. Patients were matched on age and sex. Longitudinally collected plasma samples were analyzed for levels of parameters of iron metabolism. A linear mixed model was used to assess the predictive values of the parameters. Results: In patients with AI, levels of iron, transferrin and transferrin saturation showed an early decrease compared to controls with a high Hb, already prior to the development of anemia. Ferritin, hepcidin and IL-6 levels were increased in AI compared to controls. During AI development, erythroferrone decreased. Differences in iron metabolism between groups were not influenced by APACHE IV score. Conclusions: The results show that in critically ill patients with AI, iron metabolism is already altered prior to the development of anemia. Levels of iron regulators in AI differ from septic controls with a high Hb, irrespective of disease severity. AI is characterized by high levels of hepcidin, ferritin and IL-6 and low levels of iron, transferrin and erythroferrone.
AB - Background: Anemia occurring as a result of inflammatory processes (anemia of inflammation, AI) has a high prevalence in critically ill patients. Knowledge on changes in iron metabolism during the course of AI is limited, hampering the development of strategies to counteract AI. This case control study aimed to investigate iron metabolism during the development of AI in critically ill patients. Methods: Iron metabolism in 30 patients who developed AI during ICU stay was compared with 30 septic patients with a high Hb and 30 non-septic patients with a high Hb. Patients were matched on age and sex. Longitudinally collected plasma samples were analyzed for levels of parameters of iron metabolism. A linear mixed model was used to assess the predictive values of the parameters. Results: In patients with AI, levels of iron, transferrin and transferrin saturation showed an early decrease compared to controls with a high Hb, already prior to the development of anemia. Ferritin, hepcidin and IL-6 levels were increased in AI compared to controls. During AI development, erythroferrone decreased. Differences in iron metabolism between groups were not influenced by APACHE IV score. Conclusions: The results show that in critically ill patients with AI, iron metabolism is already altered prior to the development of anemia. Levels of iron regulators in AI differ from septic controls with a high Hb, irrespective of disease severity. AI is characterized by high levels of hepcidin, ferritin and IL-6 and low levels of iron, transferrin and erythroferrone.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85046495598&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29717382
U2 - https://doi.org/10.1186/s13613-018-0407-5
DO - https://doi.org/10.1186/s13613-018-0407-5
M3 - Article
C2 - 29717382
SN - 2110-5820
VL - 8
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 56
ER -