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Prognostic Value of Different Iron Status Definitions in Congestive Heart Failure: A Retrospective MIMIC-IV Analysis
Abdulla Zahi Hourani1,2, Arman David Sürmeli1, Sai Keertana Devarapalli1
1Faculty of Medicine, English Division, Medical University of Warsaw, 02-091 Warsaw, Poland.
Insights
Iron deficiency in congestive heart failure (CHF) patients independently predicts mortality. A combined ferritin and transferrin-saturation (TSAT) model offers better risk stratification than current guidelines for predicting outcomes.
Area of Science:
- Cardiology
- Hematology
- Internal Medicine
Background:
- Iron deficiency (ID) is common in congestive heart failure (CHF) and linked to worse patient outcomes.
- Current European guidelines for ID screening in CHF use ferritin and transferrin saturation (TSAT), but diagnostic criteria are inconsistent, particularly for functional deficiency and hyperferritinemia.
- These inconsistencies limit the accuracy of predicting prognosis in hospitalized CHF patients.
Purpose of the Study:
- To evaluate different iron status definitions for predicting 365-day mortality in hospitalized CHF patients.
- To compare the prognostic accuracy of guideline-defined iron deficiency with a combined Ferritin-TSAT model.
- To assess the predictive value of iron status, including deficiency and hyperferritinemia, for mortality risk stratification.
Main Methods:
- A retrospective analysis of 1839 hospitalized CHF patients from the MIMIC-IV database was conducted.
- Iron status was categorized within 24 hours of admission using guideline criteria and a novel combined Ferritin-TSAT model.
- Adjusted Cox proportional hazards models were used to assess the association between iron status categories and 1-year mortality.
Main Results:
- Guidelines-defined iron deficiency (33.66% prevalence) was independently associated with significantly higher 1-year mortality (adjusted HR 4.36).
- The combined Ferritin-TSAT model demonstrated significant prognostic value, differentiating risk among true iron deficiency, intermediate, and hyperferritinemia groups.
- This model provided finer risk stratification compared to the binary guideline definition, better distinguishing hyperferritinemic and iron-replete subgroups.
Conclusions:
- Iron status, encompassing both deficiency and hyperferritinemia, is an independent predictor of 1-year mortality in CHF patients.
- While guideline-defined iron deficiency is a strong predictor, a combined Ferritin-TSAT classification offers improved risk stratification by identifying distinct patient phenotypes.
- A more nuanced assessment of iron status can enhance prognostic evaluation and guide personalized therapies, potentially improving CHF outcomes.
Abstract:
Background: Iron deficiency (ID) is prevalent in congestive heart failure (CHF), worsening outcomes. While European guidelines recommend screening using ferritin and transferrin-saturation (TSAT), inconsistent diagnostic criteria, especially regarding functional deficiency (ferritin 100-299 μg/L + TSAT < 20%) and hyperferritinemia, limit prognostic accuracy. This study evaluated iron status definitions, including guideline criteria and a combined Ferritin-TSAT model, for predicting 365-day mortality in hospitalised CHF patients. Methods: This retrospective analysis used MIMIC-IV data from 1839 CHF patients. Iron status within 24 h of admission was categorised using: (1) Guideline ID vs. non-ID; (2) Ferritin categories; (3) TSAT categories; (4) Combined Ferritin-TSAT model (Low: guideline ID; Intermediate: ferritin 100-299 + TSAT ≥ 20%; High: ferritin ≥ 300 μg/L). Adjusted Cox models assessed mortality associations. Results: Guidelines-defined iron deficiency (33.66% prevalence) independently associated with higher 1-year mortality (56.1% vs. 29.4%; adjusted HR 4.36, 95% CI 3.35-5.34). The combined Ferritin-TSAT model showed significant prognostic value, differentiating true iron deficiency (reference) from hyperferritinemia (adjusted HR 0.50 vs. iron deficiency) and intermediate group (adjusted HR 0.36 vs. ID), indicating varying risk relative to the most deficient group. This combined model better distinguished hyperferritinemic and iron-replete subgroups than the binary guideline definition. Conclusions: Iron status, including deficiency and hyperferritinemia, independently predicts 1-year mortality in CHF. While guideline iron deficiency is a strong predictor, a combined Ferritin-TSAT classification offers finer risk stratification by identifying distinct phenotypes (true deficiency, hyperferritinemia, intermediate). Nuanced iron status assessment could improve prognostic evaluation and guide personalised therapies (e.g., IV iron for deficiency, investigation for hyperferritinemia) to enhance CHF outcomes.
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