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Hiperferritineminin nedenleri: pandemi ile neler değişti?

Yıl 2024, Cilt: 49 Sayı: 1, 104 - 112, 29.03.2024
https://doi.org/10.17826/cumj.1379286

Öz

Amaç: Çalışmanın amacı, ferritin düzeyi 1000 ng/mL ve üzeri olan hastaların, COVID-19 pandemi öncesi ve pandemi döneminde tanılarına ve takip oldukları servislere göre dağılımını değerlendirmektir.
Gereç ve Yöntem: Bu retrospektif çalışmada, pandemi öncesi 18 ay ile pandemi başlangıcından sonraki 18 ay arasında üçüncü basamak bir hastaneye başvuran ve ferritin düzeyleri 1000 ng/mL'nin üzerinde olan hastalar değerlendirilmiştir. Hastaların demografik ve klinik özellikleri ile ferritin düzeyleri hastanenin tıbbi kayıtlarından elde edilmiştir
Tartışma: Ortanca yaşı 62(49-71) olan 635'i (%31,4) kadın ve 1387'si (%68,6) erkek olmak üzere toplam 2022 hasta vardı. Pandemi öncesinde 554 hastanın (%27.4) ferritin düzeyi 1000 ng/mL ve üzeri, pandemi sırasında ise 1468 hastanın (%72,6) ferritin düzeyi 1000 ng/mL ve üzerindeydi. Pandemi döneminde erkeklerde hiperferritinemi daha sık saptandı(p<0,001). Pandemi öncesinde en sık hiperferritinemi nedeni hematolojik maligniteler iken pandemi döneminde en sık COVID-19 yer almaktaydı. Takip oldukları servislere göre dağılımında ise pandemi öncesinde hematoloji bölümü, pandemi döneminde ise COVID-19 klinikleri hiperferritineminin en sık saptandığı bölümlerdi.
Sonuç: Bu çalışmada, hiperferritineminin en yaygın nedeninin pandemi öncesinde hematolojik maligniteler olduğu, pandemi döneminde ise COVİD-19 olduğu saptandı. Bu sebeple aşırı yüksek ferritin değerleri tespit edildiğinde önemli klinik durumlar akılda tutmak gerekse de ilk olarak hastanın klinik durumu ile uyumlu olabilecek en yaygın tabloları düşünmemiz gerektiği kanaatindeyiz.

Proje Numarası

Date: 02.03.2022 Decision No: 2022/22

Kaynakça

  • Senjo H, Higuchi T, Okada S, Takahashi O. Hyperferritinemia: causes and significance in a general hospital. Hematology. 2018;23:817-22.
  • Goldhaber G, Segal G, Dagan A. Hyperferritinemia in the elderly can differentiate the bad from the worst. Medicine (Baltimore). 2020;99:e21419.
  • Fauter M, Mainbourg S, El Jammal T, Guerber A, Zaepfel S, Henry T et al. Extreme hyperferritinemia: Causes and prognosis.J Clin Med. 2022;11:5438.
  • Ruan Q, Yang K, Wang W, Jiang L, Song J. Correction to clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:1294-97.
  • Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48:124-31.
  • Sandnes M, Ulvik RJ, Vorland M, Reikvam H. Hyperferritinemia- a clinical overview. J Clin Med. 2021;10:2008.
  • VasanthiDharmalingam P, Karuppagounder V, Watanabe K et al. SARS–CoV-2 Mediated hyperferritinemia and cardiac arrest: Preliminary ınsights. Drug Discov Today. 2021;26:1265-74.
  • Ellervik C, Marott JL, Tybjærg-Hansen A, Schnohr P, Nordestgaard BG. Total and cause-specific mortality by moderately and markedly increased ferritin concentrations: General population study and meta-analysis. Clin Chem. 2014;60:1419-28.
  • Lachmann G, Knaak C, Vorderwülbecke G, Rosee P, Balzer F, Schenk T et al. Hyperferritinemia in critically Ill patients. Crit Care Med. 2020;48:459-65.
  • Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe or critical type 2019 novel coronavirus pneumonia. Lab Invest. 2019;100:794-800.
  • Giamarellos-Bourboulis EJ, Netea MG, Rovina N, Akinosoglou K, Antoniadou A, Antonakos N et al. Complex ımmune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host Microbe. 2020;27:992-1000.e3.
  • Feld J, Tremblay D, Thibaud S, Kessler A, Naymagon L. Ferritin levels in patients with COVID‐19: A poor predictor of mortality and hemophagocytic lymphohistiocytosis. Int J Lab Hematol. 2020;42:773-79.
  • Kaya MN. Mental status of healthcare professionals according to the level of exposure to COVID-19 patients during the pandemic. J Health Sci Med. 2022;5:1081-85.
  • 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.
  • Moore C, Ormseth M, Fuchs H. Causes and significance of markedly elevated serum ferritin levels in an academic medical center. J Clin Rheumatol. 2013;19:324-8.
  • Üsküdar Cansu D, Üsküdar Teke H, Cansu GB, Korkmaz C. Evaluation of hyperferritinemia causes in rheumatology practice: a retrospective, single-center experience. Rheumatol Int. 2021;41:1617-24.
  • Wang W, Knovich MA, Coffman LG, Torti FM, Torti S V. Serum ferritin: Past, present and future. Biochim Biophys Acta. 2010;1800:760-69.
  • Araç E, Solmaz İ. Bir eğitim ve araştırma hastanesinde hiperferritinemi hastalarının analizi. STED. 2020;29:435-38.
  • Canna SW, Behrens EM. Making Sense of the Cytokine Storm: A conceptual framework for understanding, diagnosing, and treating hemophagocytic syndromes. Pediatr Clin North Am. 2012;59:329-44.
  • Behrens EM, Koretzky GA. Review: Cytokine storm syndrome: Looking toward the precision Medicine Era. Arthritis Rheumatol. 2017;69:1135-43.
  • Hunter CA, Jones SA. IL-6 as a keystone cytokine in health and disease. Nat Immunol. 2015;16:448-57.
  • Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID‐19: A single-center experience. J Med Virol. 2020;92:814-18.
  • Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117:10970-75.
  • Sciascia S, Aprà F, Baffa A, Baldovino S, Boaro D, Boero R et al. Pilot prospective open, single-arm multicentre study on off-label use of tocilizumab in patients with severe COVID-19. Clin Exp Rheumatol. 2020;38:529-32.
  • Keske Ş, Tekin S, Sait B, İrkören P, Kapmaz M, Çimen C. et al. Appropriate use of tocilizumab in COVID-19 infection. Int J Infect Dis. 2020;99:338-43.

Causes of hyperferritinemia: what has changed with the pandemic?

Yıl 2024, Cilt: 49 Sayı: 1, 104 - 112, 29.03.2024
https://doi.org/10.17826/cumj.1379286

Öz

Purpose: In this study, we aimed to analyze patients with ferritin levels of ≥ 1000 ng/mL based on diagnoses and the wards they received both before the COVID pandemic and during the pandemic periods.
Materials and Methods: This retrospective study evaluated the patients who applied to a tertiary hospital and had ferritin onset of the pandemic. The patients' demographic and clinical characteristics and ferritin levels were obtained from the hospital's medical records.
Results: There were 2022 patients, 635 (31.4%) female and 1387 (68.6%) male, with a median age of 62 (49-71) years. 554 patients (27.4%) before the pandemic, and 1468 patients (72.6%) during the pandemic had ferritin levels of ≥ 1000 ng/mL. Hyperferritinemia was detected more frequently in males during the pandemic (p<0.001). Before the pandemic, the most prevalent cause of hyperferritinemia was hematologic malignancies, while COVID-19 was the most common cause of hyperferritinemia during the pandemic. Hyperferritinemia was commonly detected in the hematology department before the pandemic, while it was frequently performed in COVID-19 clinics and intensive care units after the onset of the pandemic.
Conclusion: In the current study, the most prevalent cause of hyperferritinemia was hematological malignancies before the pandemic, and COVID-19 infection during the pandemic. Therefore, it is important to consider the most common conditions that match the patient's clinical condition when detecting extremely high ferritin values. Nevertheless, many other important clinical situations should also be kept in mind.

Etik Beyan

This study was approved by the Ethics Committee of Health Sciences University, Gulhane Training, and Research Hospital within the framework of the Declaration of Helsinki (Date: 02.03.2022 Decision No: 2022/22).

Destekleyen Kurum

Authors declared no financial support

Proje Numarası

Date: 02.03.2022 Decision No: 2022/22

Kaynakça

  • Senjo H, Higuchi T, Okada S, Takahashi O. Hyperferritinemia: causes and significance in a general hospital. Hematology. 2018;23:817-22.
  • Goldhaber G, Segal G, Dagan A. Hyperferritinemia in the elderly can differentiate the bad from the worst. Medicine (Baltimore). 2020;99:e21419.
  • Fauter M, Mainbourg S, El Jammal T, Guerber A, Zaepfel S, Henry T et al. Extreme hyperferritinemia: Causes and prognosis.J Clin Med. 2022;11:5438.
  • Ruan Q, Yang K, Wang W, Jiang L, Song J. Correction to clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:1294-97.
  • Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48:124-31.
  • Sandnes M, Ulvik RJ, Vorland M, Reikvam H. Hyperferritinemia- a clinical overview. J Clin Med. 2021;10:2008.
  • VasanthiDharmalingam P, Karuppagounder V, Watanabe K et al. SARS–CoV-2 Mediated hyperferritinemia and cardiac arrest: Preliminary ınsights. Drug Discov Today. 2021;26:1265-74.
  • Ellervik C, Marott JL, Tybjærg-Hansen A, Schnohr P, Nordestgaard BG. Total and cause-specific mortality by moderately and markedly increased ferritin concentrations: General population study and meta-analysis. Clin Chem. 2014;60:1419-28.
  • Lachmann G, Knaak C, Vorderwülbecke G, Rosee P, Balzer F, Schenk T et al. Hyperferritinemia in critically Ill patients. Crit Care Med. 2020;48:459-65.
  • Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe or critical type 2019 novel coronavirus pneumonia. Lab Invest. 2019;100:794-800.
  • Giamarellos-Bourboulis EJ, Netea MG, Rovina N, Akinosoglou K, Antoniadou A, Antonakos N et al. Complex ımmune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host Microbe. 2020;27:992-1000.e3.
  • Feld J, Tremblay D, Thibaud S, Kessler A, Naymagon L. Ferritin levels in patients with COVID‐19: A poor predictor of mortality and hemophagocytic lymphohistiocytosis. Int J Lab Hematol. 2020;42:773-79.
  • Kaya MN. Mental status of healthcare professionals according to the level of exposure to COVID-19 patients during the pandemic. J Health Sci Med. 2022;5:1081-85.
  • 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.
  • Moore C, Ormseth M, Fuchs H. Causes and significance of markedly elevated serum ferritin levels in an academic medical center. J Clin Rheumatol. 2013;19:324-8.
  • Üsküdar Cansu D, Üsküdar Teke H, Cansu GB, Korkmaz C. Evaluation of hyperferritinemia causes in rheumatology practice: a retrospective, single-center experience. Rheumatol Int. 2021;41:1617-24.
  • Wang W, Knovich MA, Coffman LG, Torti FM, Torti S V. Serum ferritin: Past, present and future. Biochim Biophys Acta. 2010;1800:760-69.
  • Araç E, Solmaz İ. Bir eğitim ve araştırma hastanesinde hiperferritinemi hastalarının analizi. STED. 2020;29:435-38.
  • Canna SW, Behrens EM. Making Sense of the Cytokine Storm: A conceptual framework for understanding, diagnosing, and treating hemophagocytic syndromes. Pediatr Clin North Am. 2012;59:329-44.
  • Behrens EM, Koretzky GA. Review: Cytokine storm syndrome: Looking toward the precision Medicine Era. Arthritis Rheumatol. 2017;69:1135-43.
  • Hunter CA, Jones SA. IL-6 as a keystone cytokine in health and disease. Nat Immunol. 2015;16:448-57.
  • Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID‐19: A single-center experience. J Med Virol. 2020;92:814-18.
  • Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117:10970-75.
  • Sciascia S, Aprà F, Baffa A, Baldovino S, Boaro D, Boero R et al. Pilot prospective open, single-arm multicentre study on off-label use of tocilizumab in patients with severe COVID-19. Clin Exp Rheumatol. 2020;38:529-32.
  • Keske Ş, Tekin S, Sait B, İrkören P, Kapmaz M, Çimen C. et al. Appropriate use of tocilizumab in COVID-19 infection. Int J Infect Dis. 2020;99:338-43.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma
Yazarlar

Özlem Kılıç 0000-0001-9582-4376

Emre Tekgöz 0000-0002-0866-1503

Seda Çolak 0000-0002-5703-6739

Ezgi Çimen Güneş 0000-0002-0156-011X

Mehmet Nur Kaya 0000-0003-4368-3078

Muhammet Çınar 0000-0002-6150-3539

Sedat Yılmaz 0000-0002-4691-3417

Proje Numarası Date: 02.03.2022 Decision No: 2022/22
Yayımlanma Tarihi 29 Mart 2024
Gönderilme Tarihi 24 Ekim 2023
Kabul Tarihi 22 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 49 Sayı: 1

Kaynak Göster

MLA Kılıç, Özlem vd. “Causes of Hyperferritinemia: What Has Changed With the Pandemic?”. Cukurova Medical Journal, c. 49, sy. 1, 2024, ss. 104-12, doi:10.17826/cumj.1379286.