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Central European Journal of Medicine

, Volume 9, Issue 1, pp 115–120 | Cite as

Significance of extremely elevated ferritin level in medical inpatients

  • Moshe Vardi
  • Tahani Hogerat
  • Sarit Cohen
  • Shai Cohen
Research Article
  • 97 Downloads

Abstract

The diagnostic and prognostic utility of extremely elevated ferritin values in hospitalized medical patients is lacking. We aimed to determine the clinical significance of ferritin levels ≥ 1000 ng/mL in adults hospitalized in the general medical service. We scanned the hospital laboratory database for ferritin values ≥ 1000 ng/mL, and evaluated the medical history, diagnoses, and survival of patients hospitalized in the general medical service. We compared the characteristics and outcomes of patients with values up-to versus above 2,999 ng/mL. Ferritin samples ranging from 1,003 to 12,170 ng/mL from 422 patients in the lower and 94 in the higher ferritin groups were included. Malignancy, repeat blood transfusions and recent chemotherapy were more prevalent in the higher ferritin group (p=0.003, p=0.002, and p<0.001, respectively). Infection (58.7%), chronic kidney disease (22.0%), and solid or hematological malignancies (21.6% and 17.1%, respectively) were the leading conditions associated with elevated ferritin. One-year survival was low, and significantly lower in patients in the higher ferritin group (10.8% vs. 16.9%, p=0.004). In conclusion, extremely elevated ferritin values in patients admitted to the general medical service are associated with multiplicity of clinical conditions and poor outcome.

Keywords

Internal Medicine Ferritin Differential Diagnosis Prognosis 

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References

  1. [1]
    Valberg LS. Plasma ferritin concentrations: their clinical significance and relevance to patient care. Canadian Medical Association journal. 1980 Jun 7;122(11):1240–1248. PubMed PMID: 6992966. Pubmed Central PMCID: 1802038. Epub 1980/06/07. engPubMedCentralPubMedGoogle Scholar
  2. [2]
    Finch CA, Bellotti V, Stray S, Lipschitz DA, Cook JD, Pippard MJ, et al. Plasma ferritin determination as a diagnostic tool. The Western journal of medicine. 1986 Nov;145(5):657–663. PubMed PMID: 3541387. Pubmed Central PMCID: 1307110. Epub 1986/11/01. engPubMedCentralPubMedGoogle Scholar
  3. [3]
    Olynyk JK, Cullen DJ, Aquilia S, Rossi E, Summerville L, Powell LW. A population-based study of the clinical expression of the hemochromatosis gene. The New England journal of medicine. 1999 Sep 2;341(10):718–724. PubMed PMID: 10471457. Epub 1999/09/02. engPubMedCrossRefGoogle Scholar
  4. [4]
    McLaren CE, McLachlan GJ, Halliday JW, Webb SI, Leggett BA, Jazwinska EC, et al. Distribution of transferrin saturation in an Australian population: relevance to the early diagnosis of hemochromatosis. Gastroenterology. 1998 Mar;114(3):543–549. PubMed PMID: 9496946. Epub 1998/03/13. engPubMedCrossRefGoogle Scholar
  5. [5]
    Adams PC, Barton JC. A diagnostic approach to hyperferritinemia with a non-elevated transferrin saturation. Journal of hepatology. 2011 Aug;55(2):453–458. PubMed PMID: 21354228. Epub 2011/03/01. engPubMedCrossRefGoogle Scholar
  6. [6]
    Lee MH, Means RT, Jr. Extremely elevated serum ferritin levels in a university hospital: associated diseases and clinical significance. The American journal of medicine. 1995 Jun;98(6):566–571. PubMed PMID: 7778572. Epub 1995/06/01. engPubMedCrossRefGoogle Scholar
  7. [7]
    Nirel N, Rosen B, Sharon A, Blondheim O, Sherf M, Samuel H, et al. The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments. International journal of medical informatics. 2010 Sep;79(9):649–657. PubMed PMID: 20655276. Epub 2010/07/27. engPubMedCrossRefGoogle Scholar
  8. [8]
    Hearnshaw S, Thompson NP, McGill A. The epidemiology of hyperferritinaemia. World journal of gastroenterology: WJG. 2006 Sep 28;12(36):5866–5869. PubMed PMID: 17007054. Epub 2006/09/29. engPubMedGoogle Scholar
  9. [9]
    Song MK, Chung JS, Seol YM, Shin HJ, Choi YJ, Cho GJ. Elevation of serum ferritin is associated with the outcome of patients with newly diagnosed multiple myeloma. The Korean journal of internal medicine. 2009 Dec;24(4):368–373. PubMed PMID: 19949737. Pubmed Central PMCID: 2784982. Epub 2009/12/02. engPubMedCentralPubMedCrossRefGoogle Scholar
  10. [10]
    Hann HW, Evans AE, Siegel SE, Wong KY, Sather H, Dalton A, et al. Prognostic importance of serum ferritin in patients with Stages III and IV neuroblastoma: the Childrens Cancer Study Group experience. Cancer research. 1985 Jun;45(6):2843–2848. PubMed PMID: 3986811. Epub 1985/06/01. engPubMedGoogle Scholar
  11. [11]
    Milman N, Pedersen LM. The serum ferritin concentration is a significant prognostic indicator of survival in primary lung cancer. Oncology reports. 2002 Jan–Feb;9(1):193–198. PubMed PMID: 11748482. Epub 2001/12/19. engPubMedGoogle Scholar
  12. [12]
    Bertola F, Veneri D, Bosio S, Battaglia P, Disperati A, Schiavon R. Hyperferritinaemia Without Iron Overload: Pathogenic and Therapeutic Implications Current Drug Targets-Immune, Endocrine & Metabolic Disorders. 2004;4(2):93–105Google Scholar
  13. [13]
    Schwarz-Eywill M, Heilig B, Bauer H, Breitbart A, Pezzutto A. Evaluation of serum ferritin as a marker for adult Still’s disease activity. Annals of the rheumatic diseases. 1992 May;51(5):683–685. PubMed PMID: 1616341. Pubmed Central PMCID: 1005709. Epub 1992/05/01. engPubMedCrossRefGoogle Scholar
  14. [14]
    Novak S, Anic F, Luke-Vrbanic TS. Extremely high serum ferritin levels as a main diagnostic tool of adult-onset Still’s disease. Rheumatology international. 2012 Apr;32(4):1091–1094. PubMed PMID: 21359498. Epub 2011/03/02. engPubMedCrossRefGoogle Scholar
  15. [15]
    Kirn DH, Fredericks D, McCutchan JA, Stites D, Shuman M. Marked elevation of the serum ferritin is highly specific for disseminated histoplasmosis in AIDS. AIDS. 1995 Oct;9(10):1204–1205. PubMed PMID: 8519465. Epub 1995/10/01. engPubMedCrossRefGoogle Scholar
  16. [16]
    Visser A, van de Vyver A. Severe hyperferritinemia in Mycobacteria tuberculosis infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2011 Jan 15;52(2):273–274. PubMed PMID: 21288855. Epub 2011/02/04. engCrossRefGoogle Scholar
  17. [17]
    Ramirez C, Rubio C, Fernandez de la Puebla RA, Aguilera C, Espejo I, Fuentes F. [Clinical significance of increased serum ferritin levels]. Medicina clinica. 2004 Apr 17;122(14):532–534. PubMed PMID: 15117645. Epub 2004/05/01. Significado clinico de los valores elevados de ferritina serica. spaPubMedGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Moshe Vardi
    • 1
    • 2
  • Tahani Hogerat
    • 3
  • Sarit Cohen
    • 1
  • Shai Cohen
    • 1
    • 3
  1. 1.Department of MedicineCarmel Medical CenterHaifaIsrael
  2. 2.Harvard Clinical Research InstituteBostonUSA
  3. 3.The Ruth and Bruce Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael

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