Background: Ferritin is an acute phase reactant and the cellular storage protein for iron. Liver cirrhosis and sepsis increase the levels of proinflammatory cytokines and stimulate ferritin synthesis resulting in rising levels of serum ferritin. Raised serum ferritin concentration was shown to predict mortality and liver related clinical complications in patients with decompensated cirrhosis. The present study was aimed to evaluate the utility of baseline and serial measurements of serum ferritin for predicting mortality and morbidity in hospitalized cirrhotic patients with sepsis.
Methods: This prospective study was conducted at a tertiary care center (Rajavithi Hospital, Bangkok) between March 2015 and November 2015. Thirty cirrhotic patients with sepsis of various types and sites of infec- tion were enrolled. Serum ferritin levels were tested at the time of admission (D1) and on the fifth day of admission (D5). Serum transferrin saturation was collected at base line. Liver-related morbidity was defined as the develop- ment of hepatic encephalopathy, spontaneous bacterial peritonitis, variceal bleeding and/or hepatorenal syndrome during admission.
Results: Thirty cirrhotic patients with sepsis were included, 57% male with a median age of 53 years. The mean serum ferritin levels on D1 and the mean ratio of serum ferritin D1/D5 between patients who died (1224.6 μg/L vs. 3237.2 μg/L; p=0.529) and those who survived (1.05 vs. 2.39, p=0.719) were not statistically significantly different. The mean transferrin saturation rates in patients who died were significantly higher than in those who survived (65.38% vs. 34.41%, p=0.012). In patients with serum transferrin saturation <30% (n=11), 81.8% (9/11) survived and 18.2% (2/11) died during hospitalization (p=0.045), whereas in patients with serum transferrin saturation ≥30% (n=19), 42.1% (8/19) survived and 57.9% (11/19) died during hospitalization (p=0.045).
Conclusion: Serum ferritin level did not predict clinical outcomes in terms of mortality and complica- tions in cirrhotic patients with sepsis. However, high serum transferrin saturation ≥30% was associated with a high mortality and could serve as an early predictor of mortality in cirrhotic patients with sepsis.