Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Hyperferritinemia is associated with inflammatory conditions, such as rheumatologic diseases. Objectives: To determine which diseases are associated with hyperferritinemia in a tertiary hospital; to compare ferritin levels between these different entities and to evaluate relationship between levels of ferritin and mortality in these patients.
Methods: A retrospective study was carried out in which all patients over 18 years with at least one determination of serum ferritin equal to or greater than 1000 ng/ml were identified in the laboratory database of our hospital between 2006 and 2016. Corresponding electronic medical records were reviewed and demographic data and clinical data were collected. Mortality was assessed at the end of follow-up. A descriptive statistical analysis and logistic regression analysis were performed in order to identify variables associated with mortality.
Results: 1979 patients were included, 1235 men with a mean age of 63.2 years (SD 17.2). Only 36 patients (1.8%) presented a rheumatologic diagnosis as the only cause of high levels of ferritin. Still’s disease and systemic Vasculitis being the main diagnoses. Table 1 shows patients’ characteristics grouped according to whether the elevation of ferritin was associated with a rheumatic disease or not. Median serum ferritin and transferrin saturation in both groups were similar. Mortality was lower for rheumatologic causes (5.9% vs 37.2%, p <0.001). Variables that were associated with mortality in multivariable logistic regression analysis were: maximum ferritin value (OR 1,0004, 95% CI 1,0003-1,0004, p <0.001) and age (OR 1.03, 95%CI 1.02-1.04, p <0.001), whereas rheumatologic diagnosis was a protective factor for mortality (OR 0.11, 95% CI 0.03-0.47, p = 0.003 ). ROC curve for ferritin and mortality showed an area under the curve of 0.59 (95%CI 0.58-0.62). Ferritin levels greater than 3000 ng/ml showed a specificity of 89.2% and a sensitivity of 19.7% for mortality, regardless of cause.
Conclusion: rheumatologic diseases, although representing a smaller percentage of the causes of elevation of ferritin above 1000 ng / ml, were associated with lower mortality than the non rheumatologic causes of hyperferritininemia. Serum ferritin levels were significantly associated with increased mortality regardless of the underlying cause.
Table1 Patients’ characteristics grouped by cause of Hyperferritininemia
|
Only rheumatologic disease (n=35) |
Other causes of ferritin elevation (n=1944) |
p |
|||
|
Female, n (%) |
13 (37.1) |
731 (37.6) |
0.96 |
||
|
Mean age, years (DS) |
62.5 (17.1) |
52.4 (21.1) |
< 0.001 |
||
|
Diagnostic |
Rheumatoid Arthritis |
4 |
Solid cancer |
497 |
|
|
SLE |
3 |
Onco-hematologic disease |
302 |
||
|
Vasculitis |
9 |
Chronic renal insufficiency |
236 |
||
|
Still´s disease |
8 |
Sepsis |
46 |
||
|
Gout |
2 |
Infections |
336 |
||
|
Seronegative arthritis and psoriatic arthritis |
3 |
Hepatic disease |
188 |
||
|
IgG4 |
1 |
Hematologic disease |
128 |
||
|
Juvenile idiopathic arthritis |
1 |
Cardiovascular |
57 |
||
|
Myositis |
1 |
Iron overload |
2 |
||
|
Others |
3 |
Others |
152 |
||
|
Serum ferritin, median (IQR) |
1622 (1264- 3639) |
1460 (1200-2140) |
0.07 |
||
|
Tranferrin saturation, %, median (IQR) |
38 (19-50) |
33 (18-55) |
0.83 |
||
|
Follow-up time, years, median (IQR) |
5.2 (1,2-10.2) |
5.7 (1.2-8.9) |
0.97 |
||
|
Mortality, n (%) |
2 (5.9) |
698 (37.2) |
<0.001 |
||
To cite this abstract in AMA style:
Gandino IJ, Pierini F, Martinez P JM, Ruta S, Scolnik M, Soriano ER. Hyperferritinemic Syndrome in a General Hospital [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/hyperferritinemic-syndrome-in-a-general-hospital/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/hyperferritinemic-syndrome-in-a-general-hospital/