ABSTRACT
Objectives:
Aim of this study was to evaluate hepcidin levels and its correlation with inflammatory markers, vitamin D levels as well as its effects on intensive care unit (ICU) mortality in critically ill coronavirus disease-2019 (COVID-19) patients.
Materials and Methods:
Adult patients those were admitted to pandemic ICU between March 1st, 2021 and May 17th 2021 were prospectively included to the study. Hepcidin levels and inflammatory markers on day 1, 2, 3 and 7, admission vitamin D levels, length of ICU stay and ICU mortality were recorded and analysed.
Results:
Median age of patients was 60.5 (52.50-71.25) and 20 (66.7%) of them was male. It was observed that hepcidin levels and lymphocyte counts were increased significantly from day 1 to day 7 (p=0.01 and p<0.01, respectively). In contrast, C-reactive protein (CRP) and procalsitonin levels were decreased from day 1 to day 7 (p=0.01 and p<0.01, respectively). In the analysis admission hepcidin levels and inflammatory markers [IL-6 (p=0.61), CRP (p=0.82) and ferritin (p=0.27)], vitamin D (p=0.13) and iron level (p=0.90) was not correlated. There was no correlation between hepcidin levels and ICU mortality (p=0.95).
Conclusion:
In this study, hepcidin levels were above normal limits in critically ill COVID-19 patients. However, our findings do not support the use of hepcidin, IL6, serum ferritin, and vitamin D levels in predicting COVID-19 mortality.
Keywords:
ICU, Hepcidin, Mortality
References
1Mahase E. Covid-19: WHO declares pandemic because of “alarming levels” of spread, severity, and inaction. Bmj. 2020;368:m1036.
2Camaschella C, Nai A, Silvestri L. Iron metabolism and iron disorders revisited in the hepcidin era. Haematologica. 2020;105:260.
3Loreal O, Cavey T, Bardou-Jacquet E, et al. Iron, hepcidin, and the metal connection. Front Pharmacol. 2014;5.
4Smith EM, Alvarez JA, Kearns MD, et al. High-dose vitamin D-3 reduces circulating hepcidin concentrations: A pilot, randomized, double-blind, placebo-controlled trial in healthy adults. Clin Nutr. 2017;36:980-5.
5Rauf A, Shariati MA, Khalil AA, et al. Hepcidin, an overview of biochemical and clinical properties. Steroids. 2020;160:108661.
6Bohn MK, Hall A, Sepiashvili L, et al. Pathophysiology of COVID-19: Mechanisms Underlying Disease Severity and Progression. Physiology (Bethesda). 2020;35:288-301.
7Edeas M, Saleh J, Peyssonnaux C. Iron: Innocent bystander or vicious culprit in COVID-19 pathogenesis? Int J Infect Dis. 2020;97:303-5.
8Zhou C, Chen Y, Ji Y, et al. Increased Serum Levels of Hepcidin and Ferritin Are Associated with Severity of COVID-19. Med Sci Monit. 2020;26:e926178.
9Sonnweber T, Boehm A, Sahanic S, et al. Persisting alterations of iron homeostasis in COVID-19 are associated with non-resolving lung pathologies and poor patients’ performance: a prospective observational cohort study. Respir Res. 2020;21:276.
10Hippchen T, Altamura S, Muckenthaler MU, et al. Hypoferremia is Associated With Increased Hospitalization and Oxygen Demand in COVID-19 Patients. Hemasphere. 2020;4:e492.
11Delaye JB, Alarcan H, Vallet N, et al. Specific changes of erythroid regulators and hepcidin in patients infected by SARS-COV-2. J Investig Med. 2022;70:934-938.
12Zhou C, Chen Y, Ji Y, et al. Increased serum levels of hepcidin and ferritin are associated with severity of COVID-19. Medical science monitor: international medical journal of experimental and clinical research. 2020;26:e926178-1.
13Nai A, Lorè NI, Pagani A, et al. Hepcidin levels predict Covid-19 severity and mortality in a cohort of hospitalized Italian patients. American journal of hematology. 2021;96:E32-E5.
14Velavan TP, Meyer CG. Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis. 2020;95:304-7.
15Henry BM, de Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58:1021-8.