Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure
Abstract Aims Transferrin saturation (TSAT), a marker of iron deficiency, reflects both serum concentrations of iron (SIC) and transferrin (STC). TSAT is susceptible to changes in each of these biomarkers. Little is known about determinants of STC and its influence on TSAT and mortality in patients...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14438 |
| _version_ | 1797661462732210176 |
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| author | Fraser J. Graham Pierpaolo Pellicori Gabriele Masini Joseph J. Cuthbert Andrew L. Clark John G. F. Cleland |
| author_facet | Fraser J. Graham Pierpaolo Pellicori Gabriele Masini Joseph J. Cuthbert Andrew L. Clark John G. F. Cleland |
| author_sort | Fraser J. Graham |
| collection | DOAJ |
| description | Abstract Aims Transferrin saturation (TSAT), a marker of iron deficiency, reflects both serum concentrations of iron (SIC) and transferrin (STC). TSAT is susceptible to changes in each of these biomarkers. Little is known about determinants of STC and its influence on TSAT and mortality in patients with heart failure. Accordingly, we studied the relationship of STC to clinical characteristics, to markers of iron deficiency and inflammation and to mortality in chronic heart failure (CHF). Methods and results Prospective cohort of patients with CHF attending a clinic serving a large local population. A total of 4422 patients were included (median age 75 (68–82) years; 40% women; 32% with left ventricular ejection fraction ≤40%). STC ≤ 2.3 g/L (lowest quartile) was associated with older age, lower SIC and haemoglobin and higher high‐sensitivity C‐reactive protein, ferritin and N‐terminal pro‐brain natriuretic peptide compared with those with STC > 2.3 g/L. In the lowest STC quartile, 624 (52%) patients had SIC ≤13 μmol/L, of whom 38% had TSAT ≥20%. For patients in the highest STC quartile, TSAT was <20% when SIC was >13 μmol/L in 185 (17%) patients. STC correlated inversely with ferritin (r = −0.52) and high‐sensitivity C‐reactive protein (r = −0.17) and directly with albumin (r = 0.29); all P < 0.001. In models adjusted for age, N‐terminal pro‐brain natriuretic peptide and haemoglobin, both higher SIC (hazard ratio 0.87 [95% CI: 0.81–0.95]) and STC (hazard ratio 0.82 [95% CI: 0.73–0.91]) were associated with lower mortality. SIC was more strongly associated with both anaemia and mortality than either STC or TSAT. Conclusions Many patients with CHF and a low STC have low SIC even when TSAT is >20% and serum ferritin >100 μg/L; such patients have a high prevalence of anaemia and a poor prognosis and might have iron deficiency but are currently excluded from clinical trials of iron repletion. |
| first_indexed | 2024-03-11T18:45:50Z |
| format | Article |
| id | doaj.art-a02a77272cdb4711ad559a7069d346a3 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-11T18:45:50Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-a02a77272cdb4711ad559a7069d346a32023-10-12T02:48:44ZengWileyESC Heart Failure2055-58222023-10-011052826283610.1002/ehf2.14438Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failureFraser J. Graham0Pierpaolo Pellicori1Gabriele Masini2Joseph J. Cuthbert3Andrew L. Clark4John G. F. Cleland5British Heart Foundation Cardiovascular Research Centre University of Glasgow Glasgow UKBritish Heart Foundation Cardiovascular Research Centre University of Glasgow Glasgow UKDepartment of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia Brescia ItalyHull University Teaching Hospitals NHS Trust Hull UKHull University Teaching Hospitals NHS Trust Hull UKBritish Heart Foundation Cardiovascular Research Centre University of Glasgow Glasgow UKAbstract Aims Transferrin saturation (TSAT), a marker of iron deficiency, reflects both serum concentrations of iron (SIC) and transferrin (STC). TSAT is susceptible to changes in each of these biomarkers. Little is known about determinants of STC and its influence on TSAT and mortality in patients with heart failure. Accordingly, we studied the relationship of STC to clinical characteristics, to markers of iron deficiency and inflammation and to mortality in chronic heart failure (CHF). Methods and results Prospective cohort of patients with CHF attending a clinic serving a large local population. A total of 4422 patients were included (median age 75 (68–82) years; 40% women; 32% with left ventricular ejection fraction ≤40%). STC ≤ 2.3 g/L (lowest quartile) was associated with older age, lower SIC and haemoglobin and higher high‐sensitivity C‐reactive protein, ferritin and N‐terminal pro‐brain natriuretic peptide compared with those with STC > 2.3 g/L. In the lowest STC quartile, 624 (52%) patients had SIC ≤13 μmol/L, of whom 38% had TSAT ≥20%. For patients in the highest STC quartile, TSAT was <20% when SIC was >13 μmol/L in 185 (17%) patients. STC correlated inversely with ferritin (r = −0.52) and high‐sensitivity C‐reactive protein (r = −0.17) and directly with albumin (r = 0.29); all P < 0.001. In models adjusted for age, N‐terminal pro‐brain natriuretic peptide and haemoglobin, both higher SIC (hazard ratio 0.87 [95% CI: 0.81–0.95]) and STC (hazard ratio 0.82 [95% CI: 0.73–0.91]) were associated with lower mortality. SIC was more strongly associated with both anaemia and mortality than either STC or TSAT. Conclusions Many patients with CHF and a low STC have low SIC even when TSAT is >20% and serum ferritin >100 μg/L; such patients have a high prevalence of anaemia and a poor prognosis and might have iron deficiency but are currently excluded from clinical trials of iron repletion.https://doi.org/10.1002/ehf2.14438Heart failureIronIron deficiencyMortalityTransferrin saturationTransferrin |
| spellingShingle | Fraser J. Graham Pierpaolo Pellicori Gabriele Masini Joseph J. Cuthbert Andrew L. Clark John G. F. Cleland Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure ESC Heart Failure Heart failure Iron Iron deficiency Mortality Transferrin saturation Transferrin |
| title | Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure |
| title_full | Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure |
| title_fullStr | Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure |
| title_full_unstemmed | Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure |
| title_short | Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure |
| title_sort | influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure |
| topic | Heart failure Iron Iron deficiency Mortality Transferrin saturation Transferrin |
| url | https://doi.org/10.1002/ehf2.14438 |
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