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FRI0601 Hyperferritinemic syndrome in a general universitary hospital
  1. F Pierini,
  2. IJ Gandino,
  3. JM Martinez Perez,
  4. S Ruta,
  5. M Scolnik,
  6. ER Soriano
  1. Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Abstract

Background Hyperferritinemia is associated with severe inflammatory conditions, such as rheumatic diseases with systemic inflammatory responses, and multiorgan dysfunction syndromes.

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 1/1/2006 and 6/30/2016. Corresponding electronic medical records were reviewed and demographic data and clinical data were collected. Mortality was assessed at the end of follow-up. Descriptive statistical analysis and logistic regression analysis were performed in order to identify variables associated with mortality.

Results A total of 1979 patients were included, 1235 men (62.4%) 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, with Still's disease (n=8) and systemic Vasculitis (n=9) 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 (see Table 1). 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 the diagnosis of a rheumatic disease was a protective factor (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 of ferritin elevation.

Table 1.

Patients' characteristics grouped by cause of Hyperferritininemia (Rheumatologic or not)

Conclusions Rheumatic diseases, represents a very small percentage of the causes of elevation of ferritin above 1000 ng/ml, and were associated with lower mortality than the non-rheumatic causes. Serum ferritin levels were significantly associated with increased mortality regardless of the underlying cause.

Disclosure of Interest None declared

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