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Early hyperferritinemia in polytrauma: a biomarker of systemic inflammation and mortality risk in a multicenter
Shunyao Chen1, Teding Chang1, Jialiu Luo1
1Department of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Insights
Early high serum ferritin levels in polytrauma patients indicate increased mortality risk and organ dysfunction. Serial monitoring of ferritin levels after injury improves risk stratification for better patient outcomes.
Area of Science:
- Critical care medicine
- Trauma surgery
- Biomarker research
Background:
- Severe polytrauma is a major global cause of death and disability.
- Hyperferritinemia is a recognized biomarker of critical illness.
- The prognostic value of hyperferritinemia in polytrauma is not well understood.
Purpose of the Study:
- To investigate the temporal dynamics of serum ferritin in polytrauma patients.
- To assess the association between ferritin levels and systemic inflammation, organ dysfunction, and mortality.
- To develop and validate a prognostic nomogram for predicting mortality in polytrauma.
Main Methods:
- Prospective observational cohort study of 1475 polytrauma patients across four trauma centers.
- Serum ferritin levels measured on admission (Day 1) and Day 7.
- Stratification by ferritin thresholds, logistic regression, ROC analysis, and nomogram development integrating ferritin, inflammatory markers (IL-6, CRP), and clinical scores (SOFA, APACHE II).
Main Results:
- Hyperferritinemia (≥ 500 ng/mL) observed in 39.3% of patients, with mortality increasing significantly with higher ferritin levels (up to 66.7% for ferritin ≥ 3000 ng/mL).
- Day 7 ferritin levels (AUC 0.807) were superior to Day 1 levels (AUC 0.686) for mortality prediction.
- Ferritin > 1000 ng/mL was an independent mortality risk factor, correlating with inflammation, organ dysfunction, and coagulopathy. Survivors showed a steeper ferritin decline.
Conclusions:
- Early hyperferritinemia in polytrauma patients is a significant predictor of adverse outcomes, reflecting systemic inflammation and organ failure.
- Serial ferritin monitoring post-injury enhances risk stratification and aids in guiding intensive care.
- Ferritin serves as a pragmatic biomarker for identifying high-risk polytrauma patients and informing targeted interventions.
Background:
Severe polytrauma is one of the leading causes of death and disability worldwide. Hyperferritinemia is increasingly recognized as a biomarker of critical illness, yet its prognostic significance in polytrauma remains underexplored. This multicenter study investigates the temporal dynamics of serum ferritin in polytrauma patients and its association with systemic inflammation, organ dysfunction, and mortality.
Methods:
A prospective observational cohort of 1475 polytrauma patients from four trauma centers was analyzed. Serum ferritin levels were measured on admission day 1 and day 7. Patients were stratified by ferritin thresholds: < 500 ng/ml, 500-999 ng/ml, 1000-2999 ng/ml, and ≥ 3000 ng/ml. Outcomes included mortality, ICU stay, complications, and organ dysfunction. Logistic regression and ROC analyses identified predictive thresholds. A prognostic nomogram integrating Day 1 ferritin, ferritin change (ΔFerritin), inflammatory markers (IL-6, CRP), and clinical scores (SOFA, APACHE II) was developed and internally validated.
Results:
Hyperferritinemia (≥ 500 ng/mL) occurred in 39.3% of patients, with mortality escalating from 9.2% (ferritin < 500) to 66.7% (ferritin ≥ 3000) (P < 0.001). Day 7 ferritin (> 655 ng/mL) outperformed day 1 levels (AUC 0.807 vs. 0.686) in mortality prediction, with 68.5% sensitivity and 87.8% specificity. Ferritin > 1000 ng/mL emerged as an independent mortality risk factor (OR = 1.91, P = 0.004), correlating with elevated inflammatory hyperferritinemia markers (IL-6, CRP), hepatic/renal dysfunction (AST↑, eGFR↓), and coagulopathy (INR↑). Survivors exhibited a steeper ferritin decline (- 233 vs. -146 ng/mL, P < 0.001), while non-survivors sustained hyperferritinemia. The prognostic nomogram demonstrated strong discriminative ability for in-hospital mortality (AUC = 0.813) and good calibration. Decision curve analysis confirmed significant clinical net benefit across a wide probability threshold range (0.1-0.8).
Conclusion:
Early hyperferritinemia predicts adverse outcomes in polytrauma, reflecting systemic inflammation and organ failure. Serial ferritin monitoring post-injury enhances risk stratification, offering a pragmatic biomarker for guiding intensive care and targeted interventions.
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