First Trimester Ferritin Is Superior over Soluble Transferrin Receptor and Hepcidin in Predicting Anemia in the Third Trimester: Result from a Cohort Study in Indonesia.

IF 2.2 Q3 HEMATOLOGY Anemia Pub Date : 2020-10-08 eCollection Date: 2020-01-01 DOI:10.1155/2020/8880045
Raden Tina Dewi Judistiani, Tita Husnitawati Madjid, Budi Handono, Hadyana Sukandar, Setyorini Irianti, Lani Gumilang, Sefita Aryuti Nirmala, Budi Setiabudiawan
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引用次数: 3

Abstract

Introduction: Anemia in the third trimester has been identified as a risk factor for maternal and fetal morbidity that might lead to mortality. Due to its high cost, finding the best marker to predict anemia became more important to allow early prevention. Only one of ferritin, hepcidin, or soluble transferrin receptors can be picked for the prediction of anemia in the third trimester especially in low-resource setting.

Objective: This study aimed at defining the best marker among ferritin, hepcidin, or soluble transferrin receptor (sTfR) in the first trimester for prediction of anemia in the third trimester. Materials, Methods, and Setting. This diagnostic study was nested on the cohort study of vitamin D and its impact during pregnancy in Indonesia. Singleton pregnant mothers with normal fetus were recruited in the first trimester from four cities in West Java, Indonesia. The 304 pregnant women were screened for hepcidin, ferritin, and sTfR level in the sera. All biomarkers were measured by ELISA. Complete blood count (CBC) was done by impedance method measurement (SysmexR). Only subjects with complete data were included in analysis for diagnostic study to compare the three markers by finding the best receiver operating curve (RoC), likelihood ratio (LR), and risk estimate (RR).

Result: One-hundred and eighty-one pregnant women were eligible for analysis. The result of this study showed that the serum ferritin level in the first trimester was the best marker to predict anemia in the third trimester of pregnancy. Hepcidin and sTfR performed poorly. A new cutoff point of ferritin level ≤27.23 ng/ml yielded the best ROC with 67% area under curve (95% CI 60%-75%, p < 0.0001, Youden index J 0.28), specificity 86.29% (95% CI 79.0%-91.8%), LR (+) 3.07 (95% CI 1.8-5.3), and RR 2.48 (95% CI 1.67-3.68). These last figures were better than the previously used cutoff point of ferritin level below 30 ng/ml.

Conclusion: This study provided evidence that the serum ferritin level ≤27.23 ng/ml in the first trimester was the best marker to predict anemia in the third trimester. It was valuably useful for secondary screening of anemia in pregnancy, targeting subjects who may need rigorous approach for iron deficiency treatment in the prevention of anemia in pregnancy.

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妊娠早期铁蛋白优于可溶性转铁蛋白受体和Hepcidin预测妊娠晚期贫血:来自印度尼西亚的一项队列研究的结果
妊娠晚期贫血已被确定为可能导致死亡的孕产妇和胎儿发病的危险因素。由于成本高,寻找预测贫血的最佳标记物对于早期预防变得更加重要。只有铁蛋白、肝磷脂或可溶性转铁蛋白受体中的一种可以用于预测妊娠晚期贫血,特别是在资源匮乏的情况下。目的:本研究旨在确定妊娠早期铁蛋白、肝磷脂或可溶性转铁蛋白受体(sTfR)中预测妊娠晚期贫血的最佳标志物。材料、方法和设置。本诊断性研究是在印度尼西亚孕妇维生素D及其影响的队列研究基础上进行的。研究人员从印度尼西亚西爪哇的四个城市招募了妊娠早期胎儿正常的单胎孕妇。对304名孕妇进行血清hepcidin、铁蛋白和sTfR水平筛查。所有生物标志物均采用ELISA检测。全血细胞计数(CBC)采用阻抗法测量(SysmexR)。只有资料完整的受试者才被纳入诊断研究的分析,通过寻找最佳的受试者工作曲线(RoC)、似然比(LR)和风险估计(RR)来比较三种标志物。结果:181例孕妇符合分析条件。本研究结果表明,妊娠前三个月血清铁蛋白水平是预测妊娠晚期贫血的最佳指标。Hepcidin和sTfR表现不佳。铁蛋白水平≤27.23 ng/ml为最佳ROC,曲线下面积67% (95% CI 60% ~ 75%, p < 0.0001,约登指数J 0.28),特异性86.29% (95% CI 79.0% ~ 91.8%), LR (+) 3.07 (95% CI 1.8 ~ 5.3), RR 2.48 (95% CI 1.67 ~ 3.68)。这些数据比之前使用的铁蛋白水平低于30 ng/ml的临界值要好。结论:本研究证明,妊娠前期血清铁蛋白水平≤27.23 ng/ml是预测妊娠晚期贫血的最佳指标。对于妊娠期贫血的二次筛查,针对需要严格缺铁治疗预防妊娠期贫血的人群,具有重要的参考价值。
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来源期刊
Anemia
Anemia HEMATOLOGY-
CiteScore
4.80
自引率
3.40%
发文量
11
审稿时长
18 weeks
期刊介绍: Anemia is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies on all types of anemia. Articles focusing on patient care, health systems, epidemiology, and animal models will be considered, among other relevant topics. Affecting roughly one third of the world’s population, anemia is a major public health concern. The journal aims to facilitate the exchange of research addressing global health and mortality relating to anemia and associated diseases.
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