Elevation of serum ferritin levels for predicting a poor outcome in hospitalized patients with influenza infection

[tetano]

Clin Microbiol Infect. 2020 Feb 28. pii: S1198-743X(20)30100-2. doi: 10.1016/j.cmi.2020.02.018. [Epub ahead of print] Elevation of serum ferritin levels for predicting a poor outcome in hospitalized patients with influenza infection.

Lalueza A¹, Ayuso B², Arrieta E², Trujillo H², Folgueira D³, Cueto C⁴, Serrano A⁵, Laureiro J², Ar?valo-Ca?as C², Castillo C², D?az-Pedroche C⁶, Lumbreras C⁷; INFLUDOC group.
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Abstract

OBJECTIVES:

There is an increasing evidence that ferritin is a key marker of macrophage activation but its potential role in influenza infection remains unexplored. The aim was to assess if hyperferritinemia (ferritin ≥500 ng/mL) could be a marker of poor prognosis in hospitalized patients with confirmed influenza A infection.
METHODS:

We prospectively recruited all hospitalized adult patients which tested positive for the influenza A rRT-PCR assay performed on respiratory samples in two consecutive influenza periods (2016-17 and 2017-18). Poor outcome was defined as the presence of at least one of the following: respiratory failure, admission to the Intensive Care Unit or in-hospital mortality.
RESULTS:

Among 494 patients, 68 (14%) developed poor outcome. One-hundred twelve patients (23%) had hyperferritinemia (39/68; 57% in the poor outcome group vs. 73/426; 17% in the remaining patients, p<0.0001). Median serum ferritin levels were significantly higher in the subgroup of patients with poor outcome (609 ng/ml (range 231-967) vs. 217 ng/ml (range 140-394), p<0.0001). In multivariate analysis, hyperferritinemia was associated with a five-fold increase in the odds ratio of developing poor outcome. After adjusting for classic influenza risk factors, ferritin remained as a significant predictive factor in all exploratory models. Ferritin levels had a good discriminative capacity with an area under the ROC curve of 0.72 (95% confidence interval (CI) 0.65-0.8, p<0.001) and an overall diagnostic accuracy for predicting poor outcome of 79.3% (95% IC 75.4-82.7%).
CONCLUSIONS:

Serum ferritin may discriminate a subgroup of patients with influenza infection with higher risk of developing poor outcome.
Copyright ? 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.


KEYWORDS:

ferritin; hyperferritinemia; influenza; outcome; respiratory failure

PMID: 32120038 DOI: 10.1016/j.cmi.2020.02.018