Hemophagocytosis, hyper-inflammatory responses, and multiple organ damages in COVID-19-associated hyperferritinemia

Area of Science:

• Infectious Diseases
• Hematology
• Critical Care Medicine

Background:

• Hyperferritinemia is frequently observed but its characteristics and prognostic implications in COVID-19 patients remain underexplored.
• Understanding hyperferritinemia in COVID-19 is crucial for identifying high-risk individuals and improving patient outcomes.

Purpose of the Study:

• To characterize COVID-19-associated hyperferritinemia.
• To investigate the relationship between hyperferritinemia and prognosis in COVID-19 patients.

Main Methods:

• Retrospective study of 268 documented COVID-19 patients.
• Patients were categorized into hyperferritinemia (≥500 µg/L) and non-hyperferritinemia (<500 µg/L) groups.
• Multivariate analysis was employed to identify predictors of in-hospital mortality.

Main Results:

• The hyperferritinemia group exhibited higher prevalence of fever, thrombocytopenia, mechanical ventilation, and in-hospital death (P < 0.001).
• Elevated IL-6, D-dimer, and hsCRP, along with decreased FIB, were observed in hyperferritinemia patients (P < 0.001).
• Higher rates of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and severe কমিউনিটি-acquired pneumonia (CSAC) were noted in the hyperferritinemia group (P < 0.001).
• Hyperferritinemia was an independent predictor of in-hospital mortality (HR 6.176, P < 0.001).

Conclusions:

• COVID-19 patients with hyperferritinemia frequently experience organ dysfunction and hyper-inflammation.
• Hyperferritinemia is associated with progression to hemophagocytic lymphohistiocytosis and increased mortality.
• Hyperferritinemia serves as a significant independent predictor for in-hospital mortality in COVID-19 patients.