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Estimating iron overload in patients with suspected liver disease and elevated serum ferritin


Boucsein, Irena; Cippà, Pietro E; Adams, Heiner. Estimating iron overload in patients with suspected liver disease and elevated serum ferritin. 2015, University of Zurich, Faculty of Medicine.

Abstract

BACKGROUND: Iron 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. METHODS: We 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 ¼ 147). RESULTS: Hyperferritinemia was predictive of iron overload only in patients with a high level of serum ferritin (>2000 mg/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. CONCLUSIONS: We established a simple and reliable method to correctly estimate iron overload in patients with suspected liver disease and elevated serum ferritin.

Abstract

BACKGROUND: Iron 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. METHODS: We 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 ¼ 147). RESULTS: Hyperferritinemia was predictive of iron overload only in patients with a high level of serum ferritin (>2000 mg/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. CONCLUSIONS: We 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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Additional indexing

Item Type:Dissertation
Referees:Krayenbuehl Pierre-Alexandre, Battegay Edouard
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
04 Faculty of Medicine > University Hospital Zurich > Institute of Pathology and Molecular Pathology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:8 July 2015
Deposited On:08 Jul 2015 13:28
Last Modified:08 Dec 2017 13:23
Publisher DOI:https://doi.org/10.1016/j.amjmed.2014.03.016

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