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Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis
Linlin Cheng1, Haolong Li1, Liubing Li1
1Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Insights
Elevated ferritin levels indicate a poorer prognosis in patients with coronavirus disease 2019 (COVID-19). This biomarker is associated with increased severity, mortality, and complications in COVID-19 patients.
Area of Science:
- Infectious Diseases
- Hematology
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) has become a global pandemic.
- Severe COVID-19 cases exhibit elevated ferritin, linked to cytokine storm and hemophagocytic lymphohistiocytosis.
- Ferritin's role in COVID-19 pathogenesis and prognosis requires clarification.
Purpose of the Study:
- To investigate the association between ferritin levels and COVID-19 severity.
- To determine if ferritin can predict prognosis in COVID-19 patients.
- To analyze ferritin levels in relation to comorbidities and critical care needs.
Main Methods:
- A meta-analysis was conducted on studies from multiple databases (PubMed, EMBASE, CNKI, SinoMed, WANFANG).
- Compared ferritin levels between non-survivors and survivors.
- Analyzed ferritin levels based on disease severity, comorbidities, ICU admission, and mechanical ventilation.
Main Results:
- Meta-analysis included 52 records with 10,614 COVID-19 patients.
- Significantly higher ferritin levels were observed in severe vs. non-severe patients (WMD 397.77) and non-survivors vs. survivors (WMD 677.17).
- Elevated ferritin correlated with comorbidities, severe acute liver injury, ICU care, and mechanical ventilation.
Conclusions:
- Ferritin is significantly associated with poor prognosis in COVID-19.
- Elevated ferritin levels can predict disease worsening and adverse outcomes.
- Ferritin serves as a potential biomarker for monitoring COVID-19 severity.
Objective:
The coronavirus disease 2019 (COVID-19) has rapidly developed into a pandemic. Increased levels of ferritin due to cytokine storm and secondary hemophagocytic lymphohistiocytosis were found in severe COVID-19 patients. Therefore, the aim of this study was to determine the role of ferritin in COVID-19.
Methods:
Studies investigating ferritin in COVID-19 were collected from PubMed, EMBASE, CNKI, SinoMed, and WANFANG. A meta-analysis was performed to compare the ferritin level between different patient groups: non-survivors versus survivors; more severe versus less severe; with comorbidity versus without comorbidity; ICU versus non-ICU; with mechanical ventilation versus without mechanical ventilation.
Results:
A total of 52 records involving 10 614 COVID-19-confirmed patients between December 25, 2019, and June 1, 2020, were included in this meta-analysis, and 18 studies were included in the qualitative synthesis. The ferritin level was significantly increased in severe patients compared with the level in non-severe patients [WMD 397.77 (95% CI 306.51-489.02), P < .001]. Non-survivors had a significantly higher ferritin level compared with the one in survivors [WMD 677.17 (95% CI 391.01-963.33), P < .001]. Patients with one or more comorbidities including diabetes, thrombotic complication, and cancer had significantly higher levels of ferritin than those without (P < .01). Severe acute liver injury was significantly associated with high levels of ferritin, and its level was associated with intensive supportive care, including ICU transfer and mechanical ventilation.
Conclusions:
Ferritin was associated with poor prognosis and could predict the worsening of COVID-19 patients.
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