TY - JOUR

T1 - Association of ferritin and transferrin saturation with all-cause mortality, and the effect of concurrent inflammation

T2 - a danish cohort study

AU - Mitchell, Nikki H.

AU - Jorgensen, Henrik L.

AU - Vojdeman, Fie J.

AU - Sennels, Henriette P.

AU - Andersen, Christen L.

AU - Kriegbaum, Margit

AU - Grand, Mia K.

AU - Bang, Christine W.

AU - Lind, Bent S.

PY - 2022

Y1 - 2022

N2 - The association between ferritin and transferrin saturation (TS), respectively, and all-cause mortality is unclear. Furthermore, the influence of concurrent inflammation has not been sufficiently elucidated. We investigated these associations and the effect of concurrently elevated C-reactive protein (CRP), and accordingly report the levels associated with lowest all-cause mortality for females and males with and without inflammation. Blood test results from 161,921 individuals were included. Statistical analyses were performed in sex-stratified subpopulations, with ferritin or TS level as continuous exposure variables, and were adjusted for age, co-morbidity and inflammation status using CRP. An interaction was used to investigate whether the effect of ferritin or TS on all-cause mortality was modified by inflammation status (CRP >= 10 mg/L or CRP < 10 mg/L). Low and high ferritin and TS levels were respectively associated with increased all-cause mortality in females and in males. These associations persisted with concurrent CRP >= 10 mg/L. The ferritin level associated with lowest mortality was 60 mu g/L for females and 125 mu g/L for males with CRP < 10 mg/L. It was 52 mu g/L for females and 118 mu g/L for males with CRP >= 10 mg/L. The TS level associated with lowest mortality was 33.9% for females and 32.3% for males with CRP < 10 mg/L. It was 28.7% for females and 30.6% for males with CRP >= 10 mg/L. Our findings can nuance clinical interpretation and further aid in defining recommended ranges for ferritin and TS.

AB - The association between ferritin and transferrin saturation (TS), respectively, and all-cause mortality is unclear. Furthermore, the influence of concurrent inflammation has not been sufficiently elucidated. We investigated these associations and the effect of concurrently elevated C-reactive protein (CRP), and accordingly report the levels associated with lowest all-cause mortality for females and males with and without inflammation. Blood test results from 161,921 individuals were included. Statistical analyses were performed in sex-stratified subpopulations, with ferritin or TS level as continuous exposure variables, and were adjusted for age, co-morbidity and inflammation status using CRP. An interaction was used to investigate whether the effect of ferritin or TS on all-cause mortality was modified by inflammation status (CRP >= 10 mg/L or CRP < 10 mg/L). Low and high ferritin and TS levels were respectively associated with increased all-cause mortality in females and in males. These associations persisted with concurrent CRP >= 10 mg/L. The ferritin level associated with lowest mortality was 60 mu g/L for females and 125 mu g/L for males with CRP < 10 mg/L. It was 52 mu g/L for females and 118 mu g/L for males with CRP >= 10 mg/L. The TS level associated with lowest mortality was 33.9% for females and 32.3% for males with CRP < 10 mg/L. It was 28.7% for females and 30.6% for males with CRP >= 10 mg/L. Our findings can nuance clinical interpretation and further aid in defining recommended ranges for ferritin and TS.

KW - Ferritins

KW - transferrin

KW - iron

KW - iron metabolism disorders

KW - iron deficiencies

KW - iron overload

KW - C-reactive protein

KW - acute-phase proteins

KW - acute-phase reaction

KW - inflammation

KW - mortality

KW - public health

KW - primary health care

KW - GENERAL-POPULATION

KW - SERUM FERRITIN

KW - IRON

U2 - 10.1080/00365513.2022.2129435

DO - 10.1080/00365513.2022.2129435

M3 - Journal article

C2 - 36218336

VL - 82

SP - 525

EP - 532

JO - Scandinavian Journal of Clinical and Laboratory Investigation. Supplement

JF - Scandinavian Journal of Clinical and Laboratory Investigation. Supplement

SN - 0085-591X

IS - 7-8

ER -