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Ferritin to Erythrocyte Sedimentation Rate Ratio: Simple Measure to Identify Macrophage Activation Syndrome in
Esraa M A Eloseily1, Francesca Minoia2, Courtney B Crayne3
1Assiut University, Assiut, Egypt, and Pediatric Rheumatology University of Alabama at Birmingham.
Objective:
Macrophage activation syndrome (MAS) is a life-threatening complication of systemic juvenile idiopathic arthritis (sJIA). Early diagnosis is critical. Classification criteria for MAS in sJIA perform less well in the setting of cytokine-directed therapies. The goal herein was to explore a simple ratio of serum ferritin to the erythrocyte sedimentation rate (ESR) for diagnosis of MAS in the setting of sJIA, and to assess ferritin alone as a screening tool for identifying MAS of multiple etiologies.
Methods:
Data from a large international cohort of sJIA patients with and without MAS, and from hospitalized patients with systemic infection (SI), were assessed for the ferritin:ESR ratio and ferritin alone to identify MAS among sJIA patients. Moreover, data from a smaller cohort of MAS patients associated with multiple etiologies and febrile hospitalized controls were explored. For both cohorts and controls, receiver operating characteristic curves (ROCs) for the ferritin:ESR ratio and ferritin alone were constructed, and areas under the curves (AUCs) were calculated. The Youden index was used to determine the optimal ferritin:ESR ratio and ferritin alone cut points for diagnosis.
Results:
A ferritin:ESR ratio of 21.5 was 82% sensitive and 78% specific for diagnosing sJIA-MAS versus active sJIA without MAS. Ferritin alone with a set sensitivity of 95% (screening tool) had an 89.3% specificity of identifying all-cause MAS versus febrile hospitalized children.
Conclusion:
The ferritin:ESR ratio is a practical tool for diagnosing MAS among sJIA patients, and serum ferritin alone is a remarkable screening tool for identifying MAS among febrile hospitalized children.
Insights
The ferritin:ESR ratio aids in diagnosing macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis (sJIA). Serum ferritin alone effectively screens for MAS in febrile children, improving early detection and management.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Clinical Diagnostics
Background:
- Macrophage activation syndrome (MAS) is a severe complication of systemic juvenile idiopathic arthritis (sJIA).
- Current classification criteria for MAS in sJIA are less effective with modern therapies.
- Early diagnosis of MAS is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the ferritin:erythrocyte sedimentation rate (ESR) ratio for diagnosing MAS in sJIA.
- To assess serum ferritin as a standalone screening tool for MAS across various etiologies.
- To improve diagnostic accuracy for MAS in critically ill children.
Main Methods:
- Analysis of international sJIA patient cohorts with and without MAS.
- Assessment of hospitalized patients with systemic infection (SI) and MAS of multiple etiologies.
- Construction of receiver operating characteristic (ROC) curves and calculation of area under the curve (AUC) for ferritin:ESR ratio and ferritin levels.
Main Results:
- A ferritin:ESR ratio of 21.5 demonstrated 82% sensitivity and 78% specificity for sJIA-MAS.
- Serum ferritin alone achieved 95% sensitivity and 89.3% specificity for identifying all-cause MAS in febrile hospitalized children.
Conclusions:
- The ferritin:ESR ratio offers a practical diagnostic method for MAS in sJIA patients.
- Serum ferritin serves as a valuable screening tool for detecting MAS in febrile hospitalized children.
- These biomarkers can enhance the early identification and management of MAS.
