Prognostic Significance of Serum Ferritin in Decompensated Cirrhosis: Insights from a Prospective Analysis

Serum ferritin reflects both iron stores and systemic inflammation, but its prognostic value in decompensated cirrhosis remains uncertain. We aimed to assess whether baseline serum ferritin predicts short-, intermediate-, and long-term outcomes in patients with decompensated cirrhosis.

In this prospective study, consecutive patients with decompensated cirrhosis were enrolled. Baseline serum ferritin was measured using a chemiluminescent immunoassay. Elevated ferritin was defined as ≥300 ng/mL in men and ≥200 ng/mL in women. Patients were followed for mortality at 30, 90, and 180 days.

Among 265 enrolled patients (mean age: 45.46 ± 11.39 years; 89.4% male), elevated ferritin was present in 96 (36.2%). Patients with elevated ferritin had significantly higher bilirubin, prothrombin time, and Model for End-Stage Liver Disease-sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores and experienced more frequent complications, particularly hepatorenal syndrome. Mortality was consistently higher in the elevated ferritin group at 30 days (15.6% vs. 4.1%; P = 0.002), 90 days (35.4% vs. 8.3%; P < 0.001), and 180 days (65.6% vs. 19.5%; P < 0.001). On multivariable analysis, elevated ferritin independently predicted 180-day mortality (adjusted odds ratio: 2.79; 95% confidence interval [CI]: 1.81-4.29). Ferritin demonstrated modest discrimination for 180-day mortality, with an area under the receiver operating characteristic curve of 0.693 (95% CI: 0.625-0.760).

Elevated serum ferritin is strongly associated with disease severity and independently predicts intermediate- and long-term mortality in decompensated cirrhosis. Ferritin may serve as a simple, cost-effective biomarker for risk stratification in this population.