Francisco Vasques-Nóvoa, Maria João Pimentel, Pedro Marques, Catarina Vale, Filipa Gomes, João Sérgio Neves, Isaac Barroso, João Tiago Guimarães, Paulo Bettencourt, Adelino F. Leite-Moreira, Roberto Roncon-Albuquerque, Jorge Almeida, João Pedro Ferreira, Fernando Friões
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引用次数: 0
摘要
背景铁蛋白通常用于评估铁储存并指导有关静脉补铁的治疗决策。本研究旨在评估 AHF 队列中铁蛋白水平的临床和预后关联,并确定铁蛋白的预后价值是否受感染、炎症激活和其他缺铁标记物的影响。结果入院时铁蛋白血浆浓度的中位数为 180 pg/mL。入院时铁蛋白水平较高的患者主要为男性,慢性肾病和饮酒的发病率较高,血压较低,临床感染的发生率较高。铁蛋白水平越高,心力衰竭住院或心血管死亡的复合风险越高(2分位数:HR 1.75;95% CI 1.10-2.79;p = 0.017;3分位数:HR 1.79;95% CI 1.08-2.97;p = 0.025),与经典的心力衰竭预后因素、炎症和铁相关标记物无关。入院血清铁或转铁蛋白饱和度三分位数、铁状态类别或指南定义的缺铁(ID)标准与主要综合结果之间没有发现明显的关联。然而,与铁利用率正常或不符合指南定义的缺铁(ID)标准的患者相比,出院时符合铁利用率缺陷、铁储存量低或指南定义的缺铁(ID)标准的患者出现综合终点的风险较低。结论铁蛋白水平升高与 AHF 的不良预后密切相关,低铁蛋白水平与良好预后相关,但对识别该人群中的 ID 没有重要价值。
Ferritin, inflammation, and iron deficiency in acute heart failure: evidence from the EDIFICA cohort
Background
Ferritin is commonly used to evaluate iron stores and guide therapeutic decisions regarding intravenous iron supplementation. However, in the context of AHF, inflammation-driven upregulation of ferritin might disrupt its correlation with iron stores, restricting iron bioavailability and potentially amplifying the inflammatory response.
Aim
This study aims to assess the clinical and prognostic associations of ferritin levels in an AHF cohort and to determine whether the prognostic value of ferritin is influenced by the presence of infection, inflammatory activation, and other markers of iron deficiency.
Methods
The association between ferritin and clinical outcomes (180 days) in AHF was evaluated in a cohort of 526 patients from the EDIFICA registry.
Results
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 and alcohol consumption, and presenting with lower blood pressure and a higher incidence of clinical infection. Higher ferritin levels were associated with 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 compared to those with normal iron utilization or who did not meet the guideline-defined ID criteria, respectively.
Conclusions
Elevated ferritin levels are independently associated with poor prognosis in AHF. Low ferritin levels are associated with a favorable outcome and do not carry significant value in identifying ID in this population.
期刊介绍:
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.