Low Serum Hepcidin Is Associated With Reduced Short‐Term Survival in Adults With Acute Liver Failure
Open accessAbstract
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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Paracetamol accounted for a weighted mean of 55.7% (range 50.0-77.8%) of severe acute liver injury (ALI) and/or ALF.
“Overall, paracetamol accounted for a weighted mean of 55.7% (range 50.0-77.8%) of severe acute liver injury (ALI) and/or ALF [201-208] and 7.3% (range 1.2-29.2%) of drug-induced liver injury (DILI) [209-219] (see Figure 7).”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [205]
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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
- ORCID
- 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
- green
- hdl.handle.net
- Licence
- 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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