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Towards a Common Definition for the Diagnosis of Iron Deficiency in Chronic Inflammatory Diseases
Patrice Cacoub1,2,3, Gabriel Choukroun4,5, Alain Cohen-Solal6
1Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
Insights
Diagnosing iron deficiency (ID) in chronic inflammatory diseases is challenging due to varied guidelines. A unified definition using serum ferritin and transferrin saturation (TSAT) improves ID detection across conditions like cancer and heart failure.
Area of Science:
- Internal Medicine
- Hematology
Background:
- Iron deficiency (ID) is common in chronic inflammatory diseases but often underdiagnosed.
- Heterogeneity in diagnostic guidelines from medical societies contributes to under-diagnosis.
Purpose of the Study:
- To evaluate a common definition for diagnosing iron deficiency in patients with cancer, heart failure (HF), inflammatory bowel disease (IBD), and chronic kidney disease (CKD).
- To compare prevalence estimates using a unified definition against existing official guidelines.
Main Methods:
- Applied a common ID definition (serum ferritin <100 μg/L and/or transferrin saturation (TSAT) <20%) to data from the French CARENFER studies.
- Included 1232 cancer, 1733 HF, 1090 IBD, and 1245 CKD patients.
- Compared prevalence with official guidelines (ESMO 2018, ESC 2016, ECCO 2015, ERBP 2013).
Main Results:
- The common definition increased ID prevalence in cancer (58.1%), HF (62.8%), and IBD (61.2%) patients compared to official guidelines.
- Prevalence estimates were similar for CKD patients (47.1%) using both methods.
- The unified definition revealed higher ID rates in HF and IBD patients.
Conclusions:
- Recommends combining serum ferritin and TSAT for a consistent ID diagnosis in chronic inflammatory diseases.
- Adopting this common definition can enhance iron deficiency screening in patients with various chronic conditions.
- A unified approach is crucial for accurate iron deficiency assessment in complex patient populations.
Abstract:
Iron deficiency (ID) in patients with chronic inflammatory diseases is frequent. However, under-diagnosis is also frequent due to the heterogeneity between guidelines from different medical societies. We applied a common definition for the diagnosis of ID to a large panel of patients with cancer, heart failure (HF), inflammatory bowel disease (IBD), and chronic kidney disease (CKD), where ID was defined as serum ferritin concentration <100 μg/L and/or a transferrin saturation (TSAT) index <20%. Prevalence estimates using this common definition were compared with that obtained with officially accepted definitions (ESMO 2018, ESC 2016, ECCO 2015, and ERBP 2013). For that purpose, we used data collected during the French CARENFER studies, which included 1232, 1733, 1090, and 1245 patients with cancer, HF, IBD, and CKD, respectively. When applying the common definition, ID prevalence increased to 58.1% (vs. 57.9%), 62.8% (49.6%), and 61.2% (23.7%) in cancer, HF, and IBD patients, respectively. Both prevalence estimates were similar (47.1%) in CKD patients. Based on our results, we recommend combining both ferritin concentration and TSAT index to define ID in patients with chronic inflammatory diseases. In those patients, adopting this common definition of ID should contribute to a better screening for ID, whatever the condition.
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