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Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients.

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Lasocki, Sigismond Lefebvre, Thibaud Mayeur, Claire Puy, Hervé Mebazaa, Alexandre Laterre, Pierre-François [UCL] Montiel, Virginie [UCL] Dujardin, Marie-France [UCL] Berghe, Caroline [UCL]

BACKGROUND: Iron deficiency is difficult to diagnose in critically ill patients, but may be frequent and may impair recovery. Measurement of hepcidin could help in the diagnosis of iron deficiency. We aim to assess if iron deficiency diagnosed using hepcidin is associated with poorer outcome one year after an intensive care unit stay. METHODS: We used the prospective FROG-ICU, multicentre (n = 28 ICUs), observational cohort study of critically ill survivors followed up one year after intensive care unit discharge. Iron deficiency was defined as hepcidin < 20 ng/l, ferritin < 100 ng/l or soluble transferrin receptor (sTfR)/log(ferritin) > 0.8, measured in blood drawn at intensive care unit discharge. Main outcomes were one-year all-cause mortality and poor quality of life (defined as a Short Form 36 (SF-36) score below the median). RESULTS: Among the 2087 patients in the FROG-ICU cohort, 1570 were discharged alive and 1161 had a blood sample available at intensive care unit discharge and were included in the analysis. Using hepcidin, 429 (37%) patients had iron deficiency, compared to 72 (6%) using ferritin alone and 151 (13%) using the sTfR/log(ferritin) ratio. Iron deficiency diagnosed according to low hepcidin was an independent predictor of one-year mortality (OR 1.51 (1.10-2.08)) as was high sTfR/log ferritin ratio (OR = 1.95 (1.27-3.00)), but low ferritin was not. Severe ID, defined as hepcidin < 10 ng/l, was also an independent predictor of poor one-year physical recovery (1.58 (1.01-2.49)). CONCLUSIONS: Iron deficiency, diagnosed using hepcidin, is very frequent at intensive care unit discharge and is associated with increased one-year mortality and poorer physical recovery. Whether iron treatment may improve these outcomes remains to be investigated.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2018
Language Anglais
Journal information "Critical care" - Vol. 22, no.1, p. 314 [1-8] (2018)
Peer reviewed yes
Publisher BioMed Central Ltd ((United Kingdom) London)
issn 1364-8535
e-issn 1466-609X
Publication status Publié
Affiliations UCL - SSS/IREC/MEDA - Pôle de médecine aiguë
UCL - (SLuc) Service de soins intensifs
MESH Subject Adult ; Anemia, Iron-Deficiency ; Chi-Square Distribution ; Cohort Studies ; Critical Illness ; Female ; Hepcidins ; Humans ; Iron ; Male ; Middle Aged ; Patient Discharge ; Prospective Studies ; Quality of Life ; Risk Factors ; Statistics, Nonparametric ; Surveys and Questionnaires
Keywords Critically ill ; Hepcidin ; Iron deficiency ; Outcome ; Quality of life
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Bibliographic reference Lasocki, Sigismond ; Lefebvre, Thibaud ; Mayeur, Claire ; Puy, Hervé ; Mebazaa, Alexandre ; et. al. Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients.. In: Critical care, Vol. 22, no.1, p. 314 [1-8] (2018)
Permanent URL http://hdl.handle.net/2078.1/218712