Serum Ferritin Levels for the Prediction of Mortality among COVID-19 Patients in an Indonesia’s National Referral Hospital

Yoshie Anto Chicamy; Annisa Safitri; Ricvan Dana Nindrea

doi:10.3889/oamjms.2022.8777

Authors

Yoshie Anto Chicamy Department of Clinical Pathology and Medical Laboratory, Faculty of Medicine, Andalas University, Dr. M. Djamil General Hospital, Padang, Indonesia
Annisa Safitri Department of Clinical Pathology and Medical Laboratory, Faculty of Medicine, Andalas University, Dr. M. Djamil General Hospital, Padang, Indonesia
Ricvan Dana Nindrea Department of Education and Research, Dr. M. Djamil General Hospital, Padang, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.8777

Keywords:

COVID-19, Ferritin, Outcome, Prediction

Abstract

BACKGROUND: Early identification of clinical outcomes is necessary for risk classification in COVID-19 patients. This study help in evaluating the progression of the disease and the patient’s therapy.

AIM: This study aims to determine serum ferritin levels for the prediction of mortality among COVID-19 patients in an Indonesia’s National Referral Hospital.

METHODS: A retrospective cohort study was conducted on 142 confirmed positive COVID-19 patients between March 2020 until March 2021 at Dr. M. Djamil General Hospital as a National Referral Hospital in Indonesia. Data obtained from medical record documents and examination of ferritin levels was carried out at the beginning of treatment. The Chi-square test and survival analysis with the log-rank test and Kaplan–Meier methods were used to analyze the data. The SPSS version 15 was used to analyze the data.

RESULTS: The serum ferritin cutoff point for COVID-19 patients that can be used to predict poor outcomes was >651.02 ng/mL with sensitivity 79.3%, specificity 80.5%, and accuracy 85.0%. Age, comorbid diabetes mellitus, number of comorbidities, symptoms of trouble breathing, oxygen saturation, severity, and mortality outcome were all associated to ferritin levels >651.02 ng/mL. The Kaplan–Meier curve showed that ferritin levels >651.02 ng/mL were associated for risk of poor outcome COVID-19 patients (HR = 8.84, [95% CI 3.59–21.73]).

CONCLUSION: The ferritin cutoff point for predicting poor prognosis in COVID-19 patients was 651.02 ng/mL. However, ferritin serum levels cannot be used as a single predictor in determining the poor outcome of COVID-19.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Gómez-Pastora J, Weigand M, Kim J, Wu X, Strayer J, Palmer AF, et al. Hyperferritinemia in critically ill COVID-19 patients - Is ferritin the product of inflammation or a pathogenic mediator? Clin Chim Acta. 2020;509:249-51. https://doi.org/10.1016/j.cca.2020.06.033 PMid:32579952 DOI: https://doi.org/10.1016/j.cca.2020.06.033

Cheng L, Li H, Li L, Liu C, Yan S, Chen H, et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal. 2020;34(10):e23618. https://doi.org/10.1002/jcla.23618 PMid:33078400 DOI: https://doi.org/10.1002/jcla.23618

Dahan S, Segal G, Katz I, Hellou T, Tietel M, Bryk G, et al. Ferritin as a marker of severity in COVID-19 patients: A fatal correlation. Isr Med Assoc J. 2020;22(8):494-500. PMid:33236582

Kappert K, Jahić A, Tauber R. Assessment of serum ferritin as a biomarker in COVID-19: Bystander or participant? Insights by comparison with other infectious and non-infectious diseases. Biomarkers. 2020;25(8):616-625. https://doi.org/10.1080/13547 50X.2020.1797880 PMid:32700561 DOI: https://doi.org/10.1080/1354750X.2020.1797880

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3 PMid:32171076 DOI: https://doi.org/10.1016/S0140-6736(20)30566-3

Mueller AL, McNamara MS, Sinclair DA. Why does COVID-19 disproportionately affect older people? Aging (Albany NY). 2020;12(10):9959-81. https://doi.org/10.18632/aging.103344 PMid:32470948 DOI: https://doi.org/10.18632/aging.103344

Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res Clin Pract. 2020;164:108214. https://doi.org/10.1016/j.diabres.2020.108214 PMid:32416121 DOI: https://doi.org/10.1016/j.diabres.2020.108214

Deng F, Zhang L, Lyu L, Lu Z, Gao D, Ma X, et al. Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19. Med Clin (Barc). 2021;156(7):324-31. https://doi.org/10.1016/j.medcli.2020.11.030 PMid:33422296 DOI: https://doi.org/10.1016/j.medcli.2020.11.030

Akdur G, Daş M, Bardakci O, Akman C, Sıddıkoğlu D, Akdur O, et al. Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index. Am J Emerg Med. 2021;50:546-52. https://doi.org/10.1016/j.ajem.2021.08.079 PMid:34547696 DOI: https://doi.org/10.1016/j.ajem.2021.08.079

Qeadan F, Tingey B, Gu LY, Packard AH, Erdei E, Saeed AI. Prognostic values of serum ferritin and D-dimer trajectory in patients with COVID-19. Viruses. 2021;13(3):419. https://doi.org/10.3390/v13030419 PMid:33807920 DOI: https://doi.org/10.3390/v13030419

Lino K, Guimarães GM, Alves LS, Oliveira AC, Faustino R, Fernandes CS, et al. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz J Infect Dis. 2021;25(2):101569. https://doi.org/10.1016/j.bjid.2021.101569 PMid:33736948 DOI: https://doi.org/10.1016/j.bjid.2021.101569

Tang JW, Young S, May S, Bird P, Bron J, Mohamedanif T, et al. Comparing hospitalised, community and staff COVID-19 infection rates during the early phase of the evolving COVID-19 epidemic. J Infect. 2020;81(4):647-79. https://doi.org/10.1016/j.jinf.2020.05.029 PMid:32442455 DOI: https://doi.org/10.1016/j.jinf.2020.05.029

Nindrea RD, Djanas D, Warsiti W, Darma IY, Hendriyani H, Sari NP. The risk factors and pregnant women’s willingness toward the SARS-CoV-2 vaccination in various countries: A systematic review and meta-analysis. Clin Epidemiol Glob Health. 2022;14:100982. https://doi.org/10.1016/j.cegh.2022.100982 PMid:35169659 DOI: https://doi.org/10.1016/j.cegh.2022.100982

Zeng Z, Yu H, Chen H, Qi W, Chen L, Chen G, et al. Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients with COVID-19 from Wuhan, China. Crit Care. 2020;24(1):525. https://doi.org/10.1186/s13054-020-03255-0 PMid:32854750 DOI: https://doi.org/10.1186/s13054-020-03255-0

Sun Y, Dong Y, Wang L, Xie H, Li B, Chang C, et al. Characteristics and prognostic factors of disease severity in patients with COVID-19: The Beijing experience. J Autoimmun. 2020;112:102473. https://doi.org/10.1016/j.jaut.2020.102473 PMid:32439209 DOI: https://doi.org/10.1016/j.jaut.2020.102473

Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428-55. https://doi.org/10.1111/all.14657 PMid:33185910 DOI: https://doi.org/10.1111/all.14657

Nindrea RD, Usman E, Katar Y, Sari NP. Acceptance of COVID-19 vaccination and correlated variables among global populations: A systematic review and meta-analysis. Clin Epidemiol Glob Health. 2021;12:100899. https://doi.org/10.1016/j.cegh.2021.100899 PMid:34746514 DOI: https://doi.org/10.1016/j.cegh.2021.100899

Cecconi M, Piovani D, Brunetta E, Aghemo A, Greco M, Ciccarelli M, et al. Early predictors of clinical deterioration in a cohort of 239 patients hospitalized for Covid-19 Infection in Lombardy, Italy. J Clin Med. 2020;9(5):1548. https://doi.org/10.3390/jcm9051548 PMid:32443899 DOI: https://doi.org/10.3390/jcm9051548