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Ferritin thresholds for cardiac and liver hemosiderosis in β-thalassemia patients: a diagnostic accuracy study
Hadi Darvishi-Khezri1, Aily Aliasgharian1, Mohammad Naderisorki1
1Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Insights
This study identifies optimal ferritin levels to screen for iron overload complications in beta-thalassemia patients. A ferritin cutoff of 1090 ng/mL best predicts liver hemosiderosis, while 2027 ng/mL is suggested for cardiac screening.
Area of Science:
- Hematology
- Medical Diagnostics
- Iron Metabolism
Background:
- Beta-thalassemia patients often experience iron overload.
- Ferritin levels are used to screen for iron overload complications.
- Accurate ferritin cutoffs are needed to detect cardiac and liver hemosiderosis.
Purpose of the Study:
- To determine the optimal serum ferritin cutoff values for screening cardiac and liver hemosiderosis in beta-thalassemia patients.
- To evaluate the diagnostic performance of ferritin levels in detecting iron overload complications.
Main Methods:
- A registry-based diagnostic study involving 1959 beta-thalassemia patients.
- Serum ferritin levels measured by chemiluminescent immunoassay.
- Cardiac and liver hemosiderosis assessed using T2*-weighted MRI as the reference standard.
Main Results:
- A ferritin cutoff of 2027 ng/mL showed 50% sensitivity and 77.4% specificity for cardiac hemosiderosis (AUC 0.66).
- A ferritin cutoff of 1090 ng/mL demonstrated 66.7% sensitivity and 68% specificity for liver hemosiderosis (AUC 0.68).
- Patients with ferritin < 2027 ng/mL had a 17.5% likelihood of cardiac hemosiderosis; 82.9% with ferritin > 1090 ng/mL may have liver hemosiderosis.
Conclusions:
- Optimal ferritin cutoff points can aid in screening for iron overload complications in beta-thalassemia.
- The identified cutoffs (1090 ng/mL for liver, 2027 ng/mL for cardiac) can assist clinicians in managing iron overload.
- Further research may refine these screening thresholds and improve patient outcomes.
Abstract:
Ferritin is frequently used to screen some dire consequences of iron overload in β-thalassemia patients. The study aimed to define the best cutoff point of ferritin to screen for cardiac and liver hemosiderosis in these cases. This was a registry-based study on β-thalassemia patients living throughout Mazandaran province, Iran (n = 1959). In this diagnostic research, the index test was ferritin levels measured by a chemiluminescent immunoassay. As a reference test, T2*-weighted magnetic resonance imaging (T2*-weighted MRI) was applied to determine cardiac and liver hemosiderosis. A cutoff point of 2027 ng/mL for ferritin showed a sensitivity of 50%, specificity 77.4%, PPV 42.1%, and NPV 82.5% for cardiac hemosiderosis (area under curve [AUC] 0.66, 95% CI 0.60-0.71, adjusted odds ratio [OR] 2.05, 95% CI 1.05-4.01). At an optimum cutoff point of 1090 ng/mL, sensitivity 66.7%, specificity 68%, PPV 82.9%, and NPV 46.8% for liver hemosiderosis were estimated (AUC 0.68, 95% CI 0.63-0.73, adjusted OR 3.93, 95% CI 2.02-7.64. The likelihood of cardiac hemosiderosis serum ferritin levels below 2027 ng/mL is 17.5%. Moreover, 82.9% of β-thalassemia patients with serum ferritin levels above 1090 ng/mL may suffer from liver hemosiderosis, regardless of the grades.
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