Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.

<h4>Background</h4>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...

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Autores principales:	Cornelia Knaak, Friederike S Schuster, Peter Nyvlt, Patrick Heeren, Claudia Spies, Thomas Schenk, Paul La Rosée, Gritta Janka, Frank M Brunkhorst, Gunnar Lachmann
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1d2ee66591754429a8a158bd0b673996
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spelling	oai:doaj.org-article:1d2ee66591754429a8a158bd0b6739962021-12-02T20:09:17ZInfluence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.1932-620310.1371/journal.pone.0254345https://doaj.org/article/1d2ee66591754429a8a158bd0b6739962021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254345https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.<h4>Trial registration</h4>The study was registered with www.ClinicalTrials.gov (NCT02854943) on August 1, 2016.Cornelia KnaakFriederike S SchusterPeter NyvltPatrick HeerenClaudia SpiesThomas SchenkPaul La RoséeGritta JankaFrank M BrunkhorstGunnar LachmannPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254345 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Cornelia Knaak Friederike S Schuster Peter Nyvlt Patrick Heeren Claudia Spies Thomas Schenk Paul La Rosée Gritta Janka Frank M Brunkhorst Gunnar Lachmann Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.<h4>Trial registration</h4>The study was registered with www.ClinicalTrials.gov (NCT02854943) on August 1, 2016.
format	article
author	Cornelia Knaak Friederike S Schuster Peter Nyvlt Patrick Heeren Claudia Spies Thomas Schenk Paul La Rosée Gritta Janka Frank M Brunkhorst Gunnar Lachmann
author_facet	Cornelia Knaak Friederike S Schuster Peter Nyvlt Patrick Heeren Claudia Spies Thomas Schenk Paul La Rosée Gritta Janka Frank M Brunkhorst Gunnar Lachmann
author_sort	Cornelia Knaak
title	Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.
title_short	Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.
title_full	Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.
title_fullStr	Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.
title_full_unstemmed	Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.
title_sort	influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/1d2ee66591754429a8a158bd0b673996
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Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients.

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