Open AccessAssociation of Hyperferritinemia With Distinct Host Response Aberrations in Patients With Community-Acquired Pneumonia
Author(s) -
Xanthe Brands,
Tjitske S. R. van Engelen,
F.M.C. de Vries,
Bastiaan W. Haak,
Augustijn M. Klarenbeek,
Maadrika M. N. P. Kanglie,
Inge A.H. van den Berk,
Alex R. Schuurman,
Hessel PetersSengers,
Natasja A. Otto,
Daniel Faber,
René Lutter,
Brendon P. Scicluna,
Jaap Stoker,
Jan M. Prins,
W. Joost Wiersinga,
Tom van der Poll
Publication year - 2022
Publication title -
the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.69
H-Index - 252
eISSN - 1537-6613
pISSN - 0022-1899
DOI - 10.1093/infdis/jiac013
Subject(s) - interquartile range , community acquired pneumonia , medicine , sepsis , pneumonia , pathophysiology , procalcitonin , intensive care unit , gastroenterology , ferritin , population , immunology , pathogenesis , systemic inflammatory response syndrome , incidence (geometry) , pneumonia severity index , physics , environmental health , optics
Background Strongly elevated ferritin levels have been proposed to reflect systemic hyperinflammation in patients admitted to the intensive care unit. Knowledge of the incidence and pathophysiological implications of hyperferritinemia in patients with acute infection admitted to a non–intensive care setting is limited. Methods We determined the association between hyperferritinemia, defined by 2 cutoff values (500 and 250 ng/mL), and aberrations in key host response mechanisms among patients with community-acquired pneumonia (CAP) on admission to a general hospital ward (clinicaltrials.gov NCT02928367; trialregister.nl NTR6163). Results Plasma ferritin levels were higher in patients with CAP (n = 174; median [interquartile ranges], 259.5 [123.1–518.3] ng/mL) than in age- and sex-matched controls without infection (n = 50; 102.8 [53.5–185.7] ng/mL); P < .001); they were ≥500 ng/mL in 46 patients (26%) and ≥250 ng/mL in 90 (52%). Measurements of 26 biomarkers reflective of distinct pathophysiological domains showed that hyperferritinemia was associated with enhanced systemic inflammation, neutrophil activation, cytokine release, endothelial cell activation and dysfunction, and activation of the coagulation system. Results were robust across different cutoff values. Conclusions Hyperferritinemia identifies patients with CAP with a broad deregulation of various host response mechanisms implicated in the pathogenesis of sepsis. This could inform future therapeutic strategies targeting subgroups within the CAP population.