Prognostic value of serum ferritin and iron metabolism subgroups for mortality in acute heart failure

This study aimed to investigate the association between iron metabolism-related parameters and in-hospital mortality in patients presenting to the emergency department (ED) with symptoms and signs of acute heart failure (AHF), and to determine the prognostic value of iron metabolism-related subgroups.

This prospective observational case series was conducted in the ED of a tertiary hospital between May 1, 2023, and February 29, 2024. A total of 941 patients who presented with AHF and met the inclusion criteria were evaluated. Demographic, clinical, and laboratory data were recorded, and their associations with short-term mortality were analyzed statistically. Serum ferritin levels and transferrin saturation (TSAT) values were classified to define subgroups of iron metabolism.

In-hospital mortality occurred in 13.8% of the patients (n = 130). Logistic regression analysis identified ferritin levels as an independent predictor of mortality. Patients with ferritin levels of 100-299 ng/mL had a 5.8-fold increased risk of mortality, while those with ferritin ≥ 300 ng/mL had a 13.6-fold increased risk (both p < 0.001). In ROC analysis, ferritin was the strongest biomarker for predicting mortality, with an AUC of 0.811 (95% CI: 0.774-0.848). At the determined cut-off value of 102.8 ng/mL, ferritin demonstrated a sensitivity of 74.5% and specificity of 75.2%. In Group 3 (ferritin ≥ 300 ng/mL + TSAT < 20%), the mortality rate was 42.5% (p < 0.001).

Elevated ferritin levels provide additional prognostic value for early risk stratification and may help identify high-risk subgroups among patients presenting to the emergency department with acute heart failure.