Serum ferritin/C-reactive protein ratio is a simple and effective biomarker for diagnosing iron deficiency in the context of systemic inflammation
Diagnosing iron deficiency is challenging in the presence of systemic inflammation. To investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of i...
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| Published in | QJM : An International Journal of Medicine Vol. 117; no. 1; pp. 9 - 15 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
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England
07.02.2024
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| Abstract | Diagnosing iron deficiency is challenging in the presence of systemic inflammation.
To investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of inflammatory syndrome.
Test prospective cohort and validation retrospective cohort.
A prospective cohort of inpatients (n = 140) assessed the correlation between CRP and SF/TS levels. The diagnostic performance of a determined ratio was evaluated for identifying iron deficiency (ID) using different definitions and in the presence of inflammation and/or chronic heart and/or kidney failure. A large validation cohort (n = 795) further assessed the predictive power of this ratio.
In a training cohort (median age 76 years [57-84]), a linear relation was observed between SF (µg/l) and CRP (mg/l), unlike with TS. The SF/CRP ratio accurately predicted ID, with receiver operating characteristic-area under the curve (ROC-AUC) values ranging from 0.85 to 0.92 for different ID definitions. A threshold of ≤6 demonstrated the highest Youden index (0.61). In the validation cohort (age 72 years [57-84]), the SF/CRP ratio exhibited an ROC-AUC of 0.88 [95% CI: 0.85-0.90], with an odds ratio of 37.9 [95% CI: 20.3-68.9] for the threshold of ≤6.
In this study, we demonstrated that the SF/CRP ratio, with a threshold of ≤6, is a simple and effective biomarker for ID, even in the presence of systemic inflammation or comorbidities. This ratio could potentially replace the complex set of criteria currently recommended by learned societies. |
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| AbstractList | Summary
Background
Diagnosing iron deficiency is challenging in the presence of systemic inflammation.
Aim
To investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of inflammatory syndrome.
Design
Test prospective cohort and validation retrospective cohort.
Methods
A prospective cohort of inpatients (n = 140) assessed the correlation between CRP and SF/TS levels. The diagnostic performance of a determined ratio was evaluated for identifying iron deficiency (ID) using different definitions and in the presence of inflammation and/or chronic heart and/or kidney failure. A large validation cohort (n = 795) further assessed the predictive power of this ratio.
Results
In a training cohort (median age 76 years [57–84]), a linear relation was observed between SF (µg/l) and CRP (mg/l), unlike with TS. The SF/CRP ratio accurately predicted ID, with receiver operating characteristic-area under the curve (ROC-AUC) values ranging from 0.85 to 0.92 for different ID definitions. A threshold of ≤6 demonstrated the highest Youden index (0.61). In the validation cohort (age 72 years [57–84]), the SF/CRP ratio exhibited an ROC-AUC of 0.88 [95% CI: 0.85–0.90], with an odds ratio of 37.9 [95% CI: 20.3–68.9] for the threshold of ≤6.
Conclusion
In this study, we demonstrated that the SF/CRP ratio, with a threshold of ≤6, is a simple and effective biomarker for ID, even in the presence of systemic inflammation or comorbidities. This ratio could potentially replace the complex set of criteria currently recommended by learned societies. Diagnosing iron deficiency is challenging in the presence of systemic inflammation. To investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of inflammatory syndrome. Test prospective cohort and validation retrospective cohort. A prospective cohort of inpatients (n = 140) assessed the correlation between CRP and SF/TS levels. The diagnostic performance of a determined ratio was evaluated for identifying iron deficiency (ID) using different definitions and in the presence of inflammation and/or chronic heart and/or kidney failure. A large validation cohort (n = 795) further assessed the predictive power of this ratio. In a training cohort (median age 76 years [57-84]), a linear relation was observed between SF (µg/l) and CRP (mg/l), unlike with TS. The SF/CRP ratio accurately predicted ID, with receiver operating characteristic-area under the curve (ROC-AUC) values ranging from 0.85 to 0.92 for different ID definitions. A threshold of ≤6 demonstrated the highest Youden index (0.61). In the validation cohort (age 72 years [57-84]), the SF/CRP ratio exhibited an ROC-AUC of 0.88 [95% CI: 0.85-0.90], with an odds ratio of 37.9 [95% CI: 20.3-68.9] for the threshold of ≤6. In this study, we demonstrated that the SF/CRP ratio, with a threshold of ≤6, is a simple and effective biomarker for ID, even in the presence of systemic inflammation or comorbidities. This ratio could potentially replace the complex set of criteria currently recommended by learned societies. BACKGROUNDDiagnosing iron deficiency is challenging in the presence of systemic inflammation.AIMTo investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of inflammatory syndrome.DESIGNTest prospective cohort and validation retrospective cohort.METHODSA prospective cohort of inpatients (n = 140) assessed the correlation between CRP and SF/TS levels. The diagnostic performance of a determined ratio was evaluated for identifying iron deficiency (ID) using different definitions and in the presence of inflammation and/or chronic heart and/or kidney failure. A large validation cohort (n = 795) further assessed the predictive power of this ratio.RESULTSIn a training cohort (median age 76 years [57-84]), a linear relation was observed between SF (µg/l) and CRP (mg/l), unlike with TS. The SF/CRP ratio accurately predicted ID, with receiver operating characteristic-area under the curve (ROC-AUC) values ranging from 0.85 to 0.92 for different ID definitions. A threshold of ≤6 demonstrated the highest Youden index (0.61). In the validation cohort (age 72 years [57-84]), the SF/CRP ratio exhibited an ROC-AUC of 0.88 [95% CI: 0.85-0.90], with an odds ratio of 37.9 [95% CI: 20.3-68.9] for the threshold of ≤6.CONCLUSIONIn this study, we demonstrated that the SF/CRP ratio, with a threshold of ≤6, is a simple and effective biomarker for ID, even in the presence of systemic inflammation or comorbidities. This ratio could potentially replace the complex set of criteria currently recommended by learned societies. |
| Author | Urbanski, G Lacout, C Requin, J Chabrun, F Delattre, E Reynier, P Lavigne, C |
| Author_xml | – sequence: 1 givenname: G orcidid: 0000-0001-5719-8423 surname: Urbanski fullname: Urbanski, G organization: MitoLab, Unité MITOVASC, UMR CNRS 6015, INSERM U1083, SFR ICAT, University of Angers, Angers, France – sequence: 2 givenname: F orcidid: 0000-0001-6871-8711 surname: Chabrun fullname: Chabrun, F organization: Department of Biochemistry and Molecular Biology, University Hospital, Angers, France – sequence: 3 givenname: C surname: Lavigne fullname: Lavigne, C organization: Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France – sequence: 4 givenname: C surname: Lacout fullname: Lacout, C organization: Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France – sequence: 5 givenname: E surname: Delattre fullname: Delattre, E organization: Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France – sequence: 6 givenname: P surname: Reynier fullname: Reynier, P organization: Department of Biochemistry and Molecular Biology, University Hospital, Angers, France – sequence: 7 givenname: J surname: Requin fullname: Requin, J organization: Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37758245$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1002/art.30623 10.1111/j.1365-2257.2006.00812.x 10.1111/ejh.12402 10.1093/ecco-jcc/jju009 10.1111/bjh.15166 10.1016/j.ijcard.2012.12.091 10.3390/diagnostics11020366 10.1371/journal.pone.0204899 10.3945/ajcn.2010.29284 10.1111/anae.13773 10.1093/intimm/dxx031 10.1016/j.trsl.2016.05.004 10.1111/ejh.12963 10.1097/MPG.0000000000001335 10.1002/ehf2.13850 10.3111/13696998.2011.639823 10.1182/blood-2018-05-815944 10.1016/S0140-6736(20)32594-0 10.1093/ajcp/aqz142 10.1002/ejhf.2036 10.1093/annonc/mdx758 10.1016/j.mam.2020.100861 10.3945/an.115.010215 10.1007/s00392-020-01631-y 10.1093/advances/nmab035 10.1093/ndt/gft033 10.1186/s12882-018-1021-3 10.1093/eurheartj/ehw128 10.1093/jn/nxz008 10.1007/s40520-022-02093-0 10.1038/ki.2012.270 10.1007/s12185-017-2212-6 |
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| Snippet | Diagnosing iron deficiency is challenging in the presence of systemic inflammation.
To investigate the relationship between plasma C-reactive protein (CRP),... Summary Background Diagnosing iron deficiency is challenging in the presence of systemic inflammation. Aim To investigate the relationship between plasma... BACKGROUNDDiagnosing iron deficiency is challenging in the presence of systemic inflammation.AIMTo investigate the relationship between plasma C-reactive... |
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| Title | Serum ferritin/C-reactive protein ratio is a simple and effective biomarker for diagnosing iron deficiency in the context of systemic inflammation |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/37758245 https://search.proquest.com/docview/2871653801 |
| Volume | 117 |
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