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Marked hyperferritinemia in critically ill cancer patients
Paul Liedgens1,2, Jan-Michel Heger1,3, Noelle Sieg1
1University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany.
Insights
Critically ill cancer patients with very high ferritin levels face poor survival outcomes. Septic shock significantly worsens prognosis, while hemophagocytic lymphohistiocytosis criteria did not impact survival in this cohort.
Area of Science:
- Critical Care Medicine
- Oncology
- Hematology
Background:
- Marked hyperferritinemia is observed in critically ill patients.
- Cancer patients with hyperferritinemia represent a vulnerable subgroup with potentially poor prognoses.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of critically ill cancer patients experiencing marked hyperferritinemia.
- To identify factors associated with survival in this patient population.
Main Methods:
- A retrospective analysis of 117 cancer patients with ferritin levels >10,000 μg/L admitted to the intensive care unit (ICU) between 2012 and 2022.
- Evaluation of patient demographics, malignancy type, critical care interventions, and survival rates.
Main Results:
- The majority (90%) had hematologic malignancies, with a median maximum ferritin level of 27,349 μg/L.
- Sepsis and septic shock criteria were met by 51% of patients; 31% met hemophagocytic lymphohistiocytosis (HLH) criteria.
- ICU, hospital, 90-day, and 1-year survival rates were 33.3%, 23.1%, 23.7%, and 11.7%, respectively. Septic shock was associated with worse survival (p=0.001).
Conclusions:
- Critically ill cancer patients with marked hyperferritinemia exhibit poor outcomes.
- The presence of septic shock is a significant negative prognostic factor.
- These findings can aid in clinical decision-making for managing this high-risk group.
Objectives:
To investigate characteristics and outcomes of critically ill cancer patients with marked hyperferritinemia.
Methods:
A single-center retrospective analysis comprising cancer patients with a ferritin level >10.000 μg/L treated in the intensive care unit (ICU) between 2012 and 2022 was conducted.
Results:
A total of 117 patients were included in the analysis. The median age was 59 years (range: 15-86 years). Females accounted for 48% of cases. 90% of patients had a hematologic malignancy. The median maximum ferritin level was 27.349 μg/L (range: 10.300-426.073 μg/L). The diagnostic criteria of septic shock were fulfilled in 51% of cases; 31% of patients had hemophagocytic lymphohistiocytosis (HLH) according to the HLH-2004 criteria. Mechanical ventilation, renal replacement therapy and the use of vasopressors were necessary in 59%, 35% and 70% of cases, respectively. The ICU, hospital, 90-day and 1-year survival rates were 33.3%, 23.1%, 23.7% and 11.7%. Patients with septic shock had a worse survival than those without septic shock (p = .001); the survival of patients who fulfilled the HLH-2004 criteria did not differ from those who did not (p = .88).
Conclusion:
Critically ill cancer patients with marked hyperferritinemia have poor outcomes. The present data may help to make informed decisions for this patient group.
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