Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients
Abstract Background Iron deficiency is difficult to diagnose in critically ill patients, but may be frequent and may impair recovery. Measurement of hepcidin could help in the diagnosis of iron deficiency. We aim to assess if iron deficiency diagnosed using hepcidin is associated with poorer outcome...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2253-0 |
| _version_ | 1819119307253088256 |
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| author | Sigismond Lasocki Thibaud Lefebvre Claire Mayeur Hervé Puy Alexandre Mebazaa Etienne Gayat on behalf of the FROG-ICU study group |
| author_facet | Sigismond Lasocki Thibaud Lefebvre Claire Mayeur Hervé Puy Alexandre Mebazaa Etienne Gayat on behalf of the FROG-ICU study group |
| author_sort | Sigismond Lasocki |
| collection | DOAJ |
| description | Abstract Background Iron deficiency is difficult to diagnose in critically ill patients, but may be frequent and may impair recovery. Measurement of hepcidin could help in the diagnosis of iron deficiency. We aim to assess if iron deficiency diagnosed using hepcidin is associated with poorer outcome one year after an intensive care unit stay. Methods We used the prospective FROG-ICU, multicentre (n = 28 ICUs), observational cohort study of critically ill survivors followed up one year after intensive care unit discharge. Iron deficiency was defined as hepcidin < 20 ng/l, ferritin < 100 ng/l or soluble transferrin receptor (sTfR)/log(ferritin) > 0.8, measured in blood drawn at intensive care unit discharge. Main outcomes were one-year all-cause mortality and poor quality of life (defined as a Short Form 36 (SF-36) score below the median). Results Among the 2087 patients in the FROG-ICU cohort, 1570 were discharged alive and 1161 had a blood sample available at intensive care unit discharge and were included in the analysis. Using hepcidin, 429 (37%) patients had iron deficiency, compared to 72 (6%) using ferritin alone and 151 (13%) using the sTfR/log(ferritin) ratio. Iron deficiency diagnosed according to low hepcidin was an independent predictor of one-year mortality (OR 1.51 (1.10–2.08)) as was high sTfR/log ferritin ratio (OR = 1.95 (1.27–3.00)), but low ferritin was not. Severe ID, defined as hepcidin < 10 ng/l, was also an independent predictor of poor one-year physical recovery (1.58 (1.01–2.49)). Conclusions Iron deficiency, diagnosed using hepcidin, is very frequent at intensive care unit discharge and is associated with increased one-year mortality and poorer physical recovery. Whether iron treatment may improve these outcomes remains to be investigated. |
| first_indexed | 2024-12-22T06:02:41Z |
| format | Article |
| id | doaj.art-2537442c026f482b9b3eed042a474e5a |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-22T06:02:41Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-2537442c026f482b9b3eed042a474e5a2022-12-21T18:36:30ZengBMCCritical Care1364-85352018-11-012211810.1186/s13054-018-2253-0Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patientsSigismond Lasocki0Thibaud Lefebvre1Claire Mayeur2Hervé Puy3Alexandre Mebazaa4Etienne Gayat5on behalf of the FROG-ICU study groupDépartement Anesthésie Réanimation, UBL Université, CHU AngersINSERM, UMR 1149/ERL CNRS 8252, Centre de Recherches sur l’inflammation, Université Paris DiderotDepartment of Anesthesia, Université Paris Diderot ; U 942 Inserm ; APHP, Burn and Critical care, Hôpitaux Universitaires Saint louis – LariboisiereINSERM, UMR 1149/ERL CNRS 8252, Centre de Recherches sur l’inflammation, Université Paris DiderotDepartment of Anesthesia, Université Paris Diderot ; U 942 Inserm ; APHP, Burn and Critical care, Hôpitaux Universitaires Saint louis – LariboisiereDepartment of Anesthesia, Université Paris Diderot ; U 942 Inserm ; APHP, Burn and Critical care, Hôpitaux Universitaires Saint louis – LariboisiereAbstract Background Iron deficiency is difficult to diagnose in critically ill patients, but may be frequent and may impair recovery. Measurement of hepcidin could help in the diagnosis of iron deficiency. We aim to assess if iron deficiency diagnosed using hepcidin is associated with poorer outcome one year after an intensive care unit stay. Methods We used the prospective FROG-ICU, multicentre (n = 28 ICUs), observational cohort study of critically ill survivors followed up one year after intensive care unit discharge. Iron deficiency was defined as hepcidin < 20 ng/l, ferritin < 100 ng/l or soluble transferrin receptor (sTfR)/log(ferritin) > 0.8, measured in blood drawn at intensive care unit discharge. Main outcomes were one-year all-cause mortality and poor quality of life (defined as a Short Form 36 (SF-36) score below the median). Results Among the 2087 patients in the FROG-ICU cohort, 1570 were discharged alive and 1161 had a blood sample available at intensive care unit discharge and were included in the analysis. Using hepcidin, 429 (37%) patients had iron deficiency, compared to 72 (6%) using ferritin alone and 151 (13%) using the sTfR/log(ferritin) ratio. Iron deficiency diagnosed according to low hepcidin was an independent predictor of one-year mortality (OR 1.51 (1.10–2.08)) as was high sTfR/log ferritin ratio (OR = 1.95 (1.27–3.00)), but low ferritin was not. Severe ID, defined as hepcidin < 10 ng/l, was also an independent predictor of poor one-year physical recovery (1.58 (1.01–2.49)). Conclusions Iron deficiency, diagnosed using hepcidin, is very frequent at intensive care unit discharge and is associated with increased one-year mortality and poorer physical recovery. Whether iron treatment may improve these outcomes remains to be investigated.http://link.springer.com/article/10.1186/s13054-018-2253-0Iron deficiencyOutcomeCritically illQuality of lifeHepcidin |
| spellingShingle | Sigismond Lasocki Thibaud Lefebvre Claire Mayeur Hervé Puy Alexandre Mebazaa Etienne Gayat on behalf of the FROG-ICU study group Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients Critical Care Iron deficiency Outcome Critically ill Quality of life Hepcidin |
| title | Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients |
| title_full | Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients |
| title_fullStr | Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients |
| title_full_unstemmed | Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients |
| title_short | Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients |
| title_sort | iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year an observational prospective study on 1161 patients |
| topic | Iron deficiency Outcome Critically ill Quality of life Hepcidin |
| url | http://link.springer.com/article/10.1186/s13054-018-2253-0 |
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