Hyperferritinemia as independent risk factor and biomarker in COVID-19 to predict severity and mortality.

Abstract

Objectives: To determine the role of deranged serum ferritin levels as independent pathogenic risk factor to predict the progression towards a worse clinical outcome in COVID-19. Study Design: Descriptive Cross Section Study. Setting: Hayatabad Medical Complex Peshawar. Period: 1 March to 10 July 2020. Material & Methods: A total of 267 patients were enrolled from COVID-19 isolation units, Hayatabad Medical Complex Peshawar Descriptive statistics were used for numerical variables. Binary logistic regression analysis was used to predict the worst outcome in patients with deranged levels of ferritin. Correlation statistic were used to quantify the correlation of ferritin with mortality and severity of the disease. Kaplan Meir test was used for survival analysis to compare the mortality rate in gender groups in COVID-19 patients with deranged ferritin levels. Results: The mean age of the patients was 53+14years. The median value of the Serum ferritin levels of Covid-19 patients was 978 ug/L the ferritin distribution in gender groups was not normally distributed (Shapiro Wilk test, p-value 0.001). 215/267(80.5%) cases reported >400 ug/Lof serum ferritin. There was a statistically significant uphill positive correlation of serum ferritin levels with an increase in age (r_s-0.213, p-0.001) and with disease outcome in terms of mortality (r_s-0.29, p-0.05). The probability case fatality in patients with deranged serum ferritin levels was 1.8 times more as compared to patients without hyperferritinemia (p-0.05, OR 1.8). The surviving capability in female gender with deranged ferritin levels in extreme of age was 65% as compared to 20% in male gender. Conclusion: More than 80% of the COVID-19 patients had abnormally higher readings of serum ferritin. The deranged ferritin levels had a statistically significant correlation with an increase in age of patient and with worst outcome in terms of death. Female gender more protective with higher chances of survival with deranged serum ferritin levels in all age groups compared to male gender.