Cited by 32Iron Metabolism and DisordersLiver Disease and TransplantationDrug-Induced Hepatotoxicity and Protection

Low Serum Hepcidin Is Associated With Reduced Short‐Term Survival in Adults With Acute Liver Failure

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Spivak, Igor, Arora, Jyoti, Meinzer, Caitlyn, Durkalski‐Mauldin, Valerie, Lee, William M., Trautwein, Christian, Fontana, Robert J., Strnad, Pavel·2019·Hepatology

Abstract

The liver has an important role in iron homeostasis through the synthesis of the serum transporter transferrin and the iron hormone hepcidin. The aim of this study was to analyze parameters of iron metabolism in a multicenter cohort of adult patients with acute liver failure (ALF) and in an acetaminophen (APAP)-induced ALF mouse model. A representative subset of 121 adults with ALF (including 66 APAP-related patients) had baseline serum samples tested for ferritin, transferrin, iron, and hepcidin. Outcomes at 3 weeks after enrollment were categorized as spontaneous survivor (SS) versus death/transplantation (NSS). Mice were assessed before (controls) and 4 and 18 hours after injection of 300 mg/kg APAP. Patients with ALF as well as APAP-treated mice displayed increased ferritin and diminished serum hepcidin and hepcidin/ferritin ratio. SS had lower iron (29.1% vs. 34.5 µmol/L; P < 0.05) and transferrin saturation (60.9% vs. 79.1%; P < 0.01), but higher hepcidin levels (8.2 vs. 2.7 ng/mL; P < 0.001) and hepcidin/ferritin ratio (0.0047 vs. 0.0009; P < 0.001) than NSS. In a multivariate analysis, a log-transformed hepcidin-containing model displayed similar prognostic power as the established Acute Liver Failure Study Group index (C-statistic 0.87 vs. 0.85) and was better than Model for End-Stage Liver Disease score (C-statistic 0.76). In mice, hepcidin levels inversely correlated with the surrogate of liver injury. Conclusion: Our findings demonstrate that several serum iron parameters significantly associate with 3-week outcomes in adults with ALF. Among them, hepcidin decreases early during experimental APAP-induced ALF, is an independent predictor and might be a useful component of future prognostic scores.

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  1. Ritchie RF, Palomaki GE, Neveux LM, Navolotskaia O, Ledue TB, Craig WY. Reference distributions for the negative acute- phase serum proteins, albumin, transferrin and transthyretin: a practical, simple and clinically relevant approach in a large co- hort. J Clin Lab Anal 1999;13:273-279.

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Authors
Spivak, I., Arora, J., Meinzer, C., Durkalski‐Mauldin, V., Lee, W. M., Trautwein, C., Fontana, R. J., & Strnad, P.
Affiliations
  • Universitätsklinikum Aachen (DE)
  • Medical University of South Carolina (US)
  • The University of Texas Southwestern Medical Center (US)
  • University of Michigan (US)
Corresponding author
Strnad, Pavel
Venue
Hepatology
Published
2019-05
Volume
69
Issue
5
Pages
2136-2149
ISSN
0270-9139 (ISSN-L)
OpenAlex
W2905762125
Cited by
32
References
37
Citations by year
2026: 4 · 2025: 6 · 2024: 3 · 2023: 9 · 2022: 1 · 2021: 4 · 2020: 5
FWCI
1.61
Type
journal article
Language
en
Open access
Locations
  • Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • Bristol-Myers Squibb
  • Sanofi
  • American Association for the Study of Liver Diseases
  • Gilead Sciences
  • Alnylam Pharmaceuticals
  • Deutsche Forschungsgemeinschaft (TRR57, STR 1095/4–1, SFB‐TRR57)
  • National Institutes of Health (U-01 58369, SFB/TRR57)
  • Genentech
  • National Institute of Diabetes and Digestive and Kidney Diseases (U‐01 58369)
Topics
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
Keywords
acute liver failure, hepcidin, iron metabolism, iron homeostasis, acetaminophen hepatotoxicity, ferritin, transferrin, transferrin saturation, prognostic factors, short-term survival, MELD score, mouse model
MeSH terms
Acetaminophen, Adult, Animals, Disease Models, Animal, Female, Humans, Iron, Male, Mice, Inbred C57BL, Middle Aged, Prospective Studies, United States, Liver Failure, Acute, Chemical and Drug Induced Liver Injury, Hepcidins

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