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Letter
Severe COVID-19 and related hyperferritinaemia: more than an innocent bystander?
  1. Piero Ruscitti1,
  2. Onorina Berardicurti1,
  3. Antonio Barile2,
  4. Paola Cipriani1,
  5. Yehuda Shoenfeld3,4,5,
  6. Annamaria Iagnocco6,
  7. Roberto Giacomelli1
  1. 1 Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Abruzzo, Italy
  2. 2 Diagnostic and Interventional Radiology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
  3. 3 Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel HaShomer, Israel
  4. 4 Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  5. 5 Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, Russia
  6. 6 Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
  1. Correspondence to Professor Annamaria Iagnocco, Scienze Cliniche e Biologiche, University of Turin, Torino 10124, Piemonte, Italy; annamaria.iagnocco1{at}gmail.com

https://doi.org/10.1136/annrheumdis-2020-217618

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    The catastrophic outbreak of acute respiratory distress syndrome induced by SARS-CoV-2 (the coronavirus disease 2019, COVID-19) has strongly confirmed the important role of systemic hyperinflammation, independently of the trigger, as a major cause of death.1 In fact, accumulating evidence suggests that a subgroup of patients with severe COVID-19 is burdened by a cytokine storm syndrome, an overwhelming systemic inflammation with a massive release of pro-inflammatory cytokines. As reported in 150 patients in Wuhan, China, a subset of patients with COVID-19 are characterised by raised levels of ferritin, which identified those patients at higher risk of poor outcome (1297.6 ng/mL in non-survivors compared with 614.0 ng/mL in survivors).1 Although the amplitude of ferritin elevation is not comparable, this finding may resemble what is observed in diseases included under the umbrella of the hyperferritinaemic syndrome.2 This syndrome includes macrophage activation syndrome (MAS), systemic juvenile idiopathic arthritis, adult-onset Still’s disease (AOSD) and catastrophic anti-phospholipid syndrome, which are burdened by severe clinical picture and high mortality rate.2 Ferritin, the common denominator of all these diseases, is an iron storage protein comprising 24 subunits of two types, heavy (FeH) and …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors All the authors meet all criteria for authorship in the ICMJE Recommendations since all authors made substantial contributions to the conception or design of the work, the acquisition and interpretation of data. All authors contributed to the critical review and revision of the manuscript and approved the final version. All the authors agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.