tetano
Editor, Senior Moderator
Clin Chim Acta
. 2023 Aug 5;117509.
doi: 10.1016/j.cca.2023.117509. Online ahead of print. Evaluation of iron metabolism in hospitalized COVID-19 patients
Thibaud Lefebvre[SUP] 1 [/SUP], Anne Boutten[SUP] 2 [/SUP], Celia Raulet-Bussian[SUP] 2 [/SUP], Alexandre Raynor[SUP] 2 [/SUP], Hana Manceau[SUP] 3 [/SUP], Hervé Puy[SUP] 4 [/SUP], Boualem Moulouel[SUP] 5 [/SUP], Caroline Schmitt[SUP] 1 [/SUP], Jean François Timsit[SUP] 6 [/SUP], Agnès Lefort[SUP] 7 [/SUP], Emmanuel Weiss[SUP] 8 [/SUP], Francois Xavier Lescure[SUP] 9 [/SUP], Jean-Damien Ricard[SUP] 10 [/SUP], Romain Sonneville[SUP] 6 [/SUP], Katell Peoc'h[SUP] 11 [/SUP]
Affiliations
Background: Iron metabolism dysregulation may play a role in organ failure observed in Coronavirus disease 2019 (COVID-19). This study aimed to explore the whole iron metabolism in hospitalized COVID-19 patients and evaluate the impact of tocilizumab.
Methods: We performed an observational multicentric cohort study, including patients with PCR-provenCOVID-19 from the intensive care unit (ICU) (n=66) and medical ward (n=38). We measured serum interleukin-6 (IL-6), ferritin, glycosylated ferritin (GF), transferrin, iron, and hepcidin. The primary outcome was death.
Results: Among the 104 patients, we observed decreased median GF percentage (35 %; IQ 23-51.5), low iron concentration (7.5μmol/L; IQ 4-14), normal but low transferrin saturation (TSAT; 21%; IQ 11-33) and increased median hepcidin concentration (58.7 ng/mL; IQ 20.1-92.1). IL-6, ferritin, and GF were independently and significantly associated with death (p=0.026, p=0.023, and p=0.009, respectively). Surprisingly, we observed a decorrelation between hepcidin and IL-6 concentrations in some patients. These findings were amplified in tocilizumab-treated patients.
Conclusion: Iron metabolism is profoundly modified in COVID-19. The pattern we observed presents differences with a typical inflammation profile. We observed uncoupled IL-6/hepcidin levels in some patients. The benefit of additive iron chelation therapy should be questionable in this setting.
Keywords: COVID-19; Tocilizumab; ferritin; hepcidin; hypoxia; interleukin-6; iron.
. 2023 Aug 5;117509.
doi: 10.1016/j.cca.2023.117509. Online ahead of print. Evaluation of iron metabolism in hospitalized COVID-19 patients
Thibaud Lefebvre[SUP] 1 [/SUP], Anne Boutten[SUP] 2 [/SUP], Celia Raulet-Bussian[SUP] 2 [/SUP], Alexandre Raynor[SUP] 2 [/SUP], Hana Manceau[SUP] 3 [/SUP], Hervé Puy[SUP] 4 [/SUP], Boualem Moulouel[SUP] 5 [/SUP], Caroline Schmitt[SUP] 1 [/SUP], Jean François Timsit[SUP] 6 [/SUP], Agnès Lefort[SUP] 7 [/SUP], Emmanuel Weiss[SUP] 8 [/SUP], Francois Xavier Lescure[SUP] 9 [/SUP], Jean-Damien Ricard[SUP] 10 [/SUP], Romain Sonneville[SUP] 6 [/SUP], Katell Peoc'h[SUP] 11 [/SUP]
Affiliations
- PMID: 37549821
- DOI: 10.1016/j.cca.2023.117509
Background: Iron metabolism dysregulation may play a role in organ failure observed in Coronavirus disease 2019 (COVID-19). This study aimed to explore the whole iron metabolism in hospitalized COVID-19 patients and evaluate the impact of tocilizumab.
Methods: We performed an observational multicentric cohort study, including patients with PCR-provenCOVID-19 from the intensive care unit (ICU) (n=66) and medical ward (n=38). We measured serum interleukin-6 (IL-6), ferritin, glycosylated ferritin (GF), transferrin, iron, and hepcidin. The primary outcome was death.
Results: Among the 104 patients, we observed decreased median GF percentage (35 %; IQ 23-51.5), low iron concentration (7.5μmol/L; IQ 4-14), normal but low transferrin saturation (TSAT; 21%; IQ 11-33) and increased median hepcidin concentration (58.7 ng/mL; IQ 20.1-92.1). IL-6, ferritin, and GF were independently and significantly associated with death (p=0.026, p=0.023, and p=0.009, respectively). Surprisingly, we observed a decorrelation between hepcidin and IL-6 concentrations in some patients. These findings were amplified in tocilizumab-treated patients.
Conclusion: Iron metabolism is profoundly modified in COVID-19. The pattern we observed presents differences with a typical inflammation profile. We observed uncoupled IL-6/hepcidin levels in some patients. The benefit of additive iron chelation therapy should be questionable in this setting.
Keywords: COVID-19; Tocilizumab; ferritin; hepcidin; hypoxia; interleukin-6; iron.