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The following is a summary of “Ferritin, inflammation, and iron deficiency in acute heart failure: evidence from the EDIFICA cohort,” published in the September 2024 issue of Cardiology by Vasques-Nóvoa et al.

While commonly used for assessing iron stores in acute heart failure (AHF), Ferritin may be influenced by inflammation, potentially limiting its effectiveness and exacerbating the inflammatory response.

Researchers conducted a retrospective study to evaluate ferritin levels’ clinical and prognostic significance in AHF, considering the impact of infection, inflammation, and other iron deficiency markers.

They evaluated the association between ferritin and clinical outcomes (180 days) in an AHF cohort of 526 patients from the EDIFICA registry.

The results showed that the median ferritin plasma concentration at admission was 180 pg/mL. Patients with higher ferritin levels at admission were predominantly men, exhibiting a high prevalence of chronic kidney disease (CKD) and alcohol consumption and presenting with lower blood pressure and a higher incidence of clinical infection. Higher ferritin levels were associated with an increased risk of the composite of heart failure hospitalization or cardiovascular death (Tertile 2: HR 1.75; 95% CI 1.10–2.79;  P=0.017; Tertile 3: HR 1.79; 95% CI 1.08–2.97; P=0.025), independently of classical HF prognostic factors, inflammatory and iron-related markers. No significant associations were found between admission serum iron or transferrin saturation tertiles, iron status categories, or guideline-defined iron deficiency (ID) criteria and the primary composite outcome. However, at discharge, patients who met the criteria for defective iron utilization, low iron storage, or guideline-defined ID had a lower risk of the composite endpoint than those with normal iron utilization or did not meet the guideline-defined ID criteria respectively.

They concluded that high ferritin levels predict poor outcomes in AHF, while low levels were associated with favorable outcomes and do not reliably identify iron deficiency.

Source: link.springer.com/article/10.1007/s00392-024-02535-x