Estimating Iron Overload in Patients with Suspected Liver Disease and Elevated Serum Ferritin |
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| Institution: | 1. Division of Internal Medicine, University Hospital Zurich, Switzerland;2. Division of Pathology, University Hospital Zurich, Switzerland;1. Department of Internal Medicine, San Camillo Hospital, Rome, Italy;2. Department of Radiology, San Camillo Hospital, Rome, Italy;3. Department of Rheumatology, San Camillo Hospital, Rome, Italy;1. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada;2. Foundation IRCCS Ca'' Granda – Ospedale Maggiore Policlinico, Geriatrics & Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;3. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom;4. Population Health Research Institute, Hamilton, Ontario, Canada;5. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands;1. Department of Internal Medicine, University of Arizona, Tucson;2. Division of Cardiovascular Diseases, Sarver Heart Center, University of Arizona, Tucson;1. Departments of Hospital Medicine and Internal Medicine, Barnes-Jewish Hospital, Saint Louis, MO;2. Departments of Hospital Medicine and Internal Medicine, Veterans Affairs St. Louis Health Care System: John Cochran Division, Saint Louis, MO;3. Departments of Hospital Medicine and Internal Medicine, Washington University School of Medicine, Saint Louis, MO;4. Departments of Internal Medicine and Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO |
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| Abstract: | BackgroundIron status evaluation in patients with suspected liver disease and elevated serum ferritin is often challenging because hyperferritinemia does not always indicate iron overload. A reliable approach to estimate iron overload without exposing the patient to unnecessary investigations would help the clinician to identify patients who may take advantage of iron-removal therapy.MethodsWe analyzed all liver biopsies, including measurement of hepatic iron concentration, performed at the University Hospital Zurich from 1997 to 2010 to identify clinical and laboratory predictors of iron overload in patients with elevated serum ferritin (n = 147).ResultsHyperferritinemia was predictive of iron overload only in patients with a high level of serum ferritin (>2000 μg/L). In patients with moderate hyperferritinemia, liver transaminases inversely correlated with hepatic iron concentration. A combination of both parameters expressed as ferritin/aspartate transaminase ratio was highly predictive of tissue iron overload (sensitivity 83.3%, specificity 78.6%). Receiver operating characteristic analysis resulted in an area under the curve of 0.83.ConclusionsWe established a simple and reliable method to correctly estimate iron overload in patients with suspected liver disease and elevated serum ferritin. |
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| Keywords: | Ferritin Iron metabolism Iron overload |
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