Early increase of serum ferritin among COVID-19 patients is associated with need of invasive mechanical ventilation and with in-hospital death

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Diego Ramonfaura , Gloria M. Aguirre-Garcíab , Carlos A. Diaz-Garzab, Guillermo Torre-Amioneb , Victor M. Sanchez-Navab, Reynaldo Lara-Medranob, María T. Ramírez-Elizondob , Alejandra C. Esparza-Sandovalb, Francisco J. Ortega-Hernándezb & Michel F. Martínez-Reséndezbc*a Harvard Medical School, Division of Postgraduate Medical Education, Boston, MA, USAb School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexicoc Epidemiological Surveillance Unit, Hospital San Jose-Tec Salud, Monterrey, MexicoSupplemental data for this article is available online at https://doi.org/10.1080/23744235.2022.2101691.CONTACT Michel F. Martínez-Reséndez michel.martinez@tecsalud.mx School of Medicine and Health Sciences, Instituto Tecnologico y de Estudios Superiores de Monterrey, Mexico. Av. Ignacio Morones Prieto 3000, Monterrey, 64710, MexicoAbstractBackground COVID-19 may trigger an acute hyperinflammatory syndrome characterised by heightened levels of acute phase reactants and is associated with adverse outcomes among hospitalised individuals. The relationship between 48-hour changes in acute phase reactants and adverse outcomes is unclear. This study evaluated the relationship between change in four acute phase reactants (interleukin-6, procalcitonin, ferritin, and C-reactive protein), and the risk for in-hospital death and invasive mechanical ventilation.Methods A retrospective cohort among 2,523 adult patients hospitalised with COVID-19 pneumonia was conducted. Changes in IL-6, procalcitonin, ferritin, and CRP from admission to 48 h after admission were recorded. Delta was calculated using the difference in each acute phase reactant at admission and at 48-hours. Delta in acute phase reactants and the risk for in-hospital death and invasive mechanical ventilation was assessed using logistic regression models adjusting for demographics and comorbidities.Results Patients with both admission and 48-hour measurement for interleukin-6 (IL-6) (n = 541), procalcitonin (n = 828), ferritin (n = 1022), and C-reactive protein (CRP) (n = 1919) were included. Baseline characteristics were similar across all four populations. Increases in ferritin associated with a heightened risk of in-hospital death (OR 1.00032; 95%CI 1.00007- 1.00056; p < .001) and invasive mechanical ventilation (OR 1.00035; 95%CI 1.00014- 1.00055; p = .001). Therefore, for every 100 ng/mL increase in ferritin, the odds for in-hospital death and invasive mechanical ventilation increase by 3.2% and 3.5%, respectively.Conclusions Delta in ferritin is associated with in-hospital death and invasive mechanical ventilation. Other acute phase reactants were not associated with these outcomes among COVID-19 inpatients.

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