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Hyperferritinemia in Critically Ill Patients.

Gunnar Lachmann1,2, Cornelia Knaak1, Gerald Vorderwülbecke1

  • 1Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353 Berlin, Germany.

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Summary
This summary is machine-generated.

Severely elevated ferritin levels can indicate hemophagocytic lymphohistiocytosis (HLH) in critically ill patients. A ferritin level of 9,083 µg/L demonstrated high accuracy in diagnosing HLH, suggesting its inclusion in sepsis lab panels.

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Area of Science:

  • Critical Care Medicine
  • Hematology
  • Immunology

Background:

  • Hyperferritinemia is common in critically ill patients.
  • Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening condition associated with extremely high ferritin levels.
  • Differentiating HLH from other causes of hyperferritinemia is crucial for timely and appropriate management in intensive care units (ICUs).

Purpose of the Study:

  • To analyze ferritin levels in a mixed ICU cohort to differentiate HLH from other causes of hyperferritinemia.
  • To establish the diagnostic accuracy of ferritin levels for identifying HLH in critically ill patients.
  • To investigate the association between ferritin levels and in-hospital mortality.

Main Methods:

  • Retrospective observational study involving adult ICU patients with hyperferritinemia (≥ 500 µg/L) between January 2006 and August 2018.
  • Patients were categorized into HLH, sepsis, septic shock, and other diagnoses based on established criteria (HLH-2004, HScore).
  • Statistical analysis was performed to compare ferritin levels across groups and determine the diagnostic performance of specific ferritin thresholds for HLH.

Main Results:

  • Of 2,623 patients with hyperferritinemia, 40 (1.52%) were diagnosed with HLH.
  • Maximum ferritin levels were significantly higher in HLH patients compared to sepsis, septic shock, and other diagnoses (p < 0.001).
  • A maximum ferritin level of 9,083 µg/L exhibited high sensitivity (92.5%) and specificity (91.9%) for HLH diagnosis (AUC, 0.963).
  • Elevated ferritin levels were associated with increased in-hospital mortality (OR, 1.518 per log µg/L; p < 0.001).

Conclusions:

  • Ferritin levels are distinctly different across various critical conditions, with the highest levels observed in HLH.
  • A maximum ferritin threshold of 9,083 µg/L can aid in the diagnosis of HLH in the ICU setting.
  • Incorporating ferritin measurement into routine sepsis laboratory panels is recommended to improve HLH detection.