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Evaluation of iron metabolism in hospitalized COVID-19 patients

Thibaud Lefebvre1, Anne Boutten2, Célia Raulet-Bussian2

  • 1Centre Français des Porphyries, Hôpital Louis Mourier, DMU BIOGEM, APHP, Colombes, France; Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM, UMR1149, Laboratoire d'Excellence GR-Ex, Paris, France.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|August 7, 2023
PubMed

Insights

COVID-19 significantly alters iron metabolism, with decreased glycosylated ferritin and low iron levels observed. Elevated ferritin and glycosylated ferritin are linked to mortality, suggesting complex iron dysregulation in severe cases.

Area of Science:

  • Biochemistry
  • Immunology
  • Critical Care Medicine

Background:

  • Iron metabolism dysregulation is implicated in organ failure in Coronavirus disease 2019 (COVID-19).
  • Understanding iron profiles in COVID-19 patients is crucial for managing disease progression and organ damage.

Purpose of the Study:

  • To investigate the comprehensive iron metabolism in hospitalized COVID-19 patients.
  • To evaluate the influence of tocilizumab on iron parameters and patient outcomes.

Main Methods:

  • An observational, multicentric cohort study involving 104 hospitalized COVID-19 patients (66 ICU, 38 medical ward).
  • Serum levels of interleukin-6 (IL-6), ferritin, glycosylated ferritin (GF), transferrin, iron, and hepcidin were measured.
  • The primary endpoint was mortality.

Main Results:

  • Patients exhibited decreased median glycosylated ferritin (35%), low iron concentration (7.5 μmol/L), and low transferrin saturation (21%).
  • Hepcidin concentration was elevated (58.7 ng/mL), with some patients showing a dissociation between IL-6 and hepcidin.
  • Increased IL-6, ferritin, and GF were independently associated with a higher risk of death, effects amplified by tocilizumab.

Conclusions:

  • COVID-19 profoundly alters iron metabolism, deviating from typical inflammatory patterns.
  • Uncoupled IL-6/hepcidin levels were observed in a subset of patients.
  • The efficacy of additional iron chelation therapy in COVID-19 warrants careful consideration due to these unique metabolic alterations.
Abstract

Keywords:
COVID-19FerritinHepcidinHypoxiaInterleukin-6IronTocilizumab

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