Iron metabolism in critically ill patients developing anemia of inflammation: a case control study
Open accessAbstract
BACKGROUND: Anemia occurring as a result of inflammatory processes (anemia of inflammation, AI) has a high prevalence in critically ill patients. Knowledge on changes in iron metabolism during the course of AI is limited, hampering the development of strategies to counteract AI. This case control study aimed to investigate iron metabolism during the development of AI in critically ill patients. METHODS: Iron metabolism in 30 patients who developed AI during ICU stay was compared with 30 septic patients with a high Hb and 30 non-septic patients with a high Hb. Patients were matched on age and sex. Longitudinally collected plasma samples were analyzed for levels of parameters of iron metabolism. A linear mixed model was used to assess the predictive values of the parameters. RESULTS: In patients with AI, levels of iron, transferrin and transferrin saturation showed an early decrease compared to controls with a high Hb, already prior to the development of anemia. Ferritin, hepcidin and IL-6 levels were increased in AI compared to controls. During AI development, erythroferrone decreased. Differences in iron metabolism between groups were not influenced by APACHE IV score. CONCLUSIONS: The results show that in critically ill patients with AI, iron metabolism is already altered prior to the development of anemia. Levels of iron regulators in AI differ from septic controls with a high Hb, irrespective of disease severity. AI is characterized by high levels of hepcidin, ferritin and IL-6 and low levels of iron, transferrin and erythroferrone.
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Functional deficiencies of iron and erythropoietin are common in the critically ill.
“In addition, functional deficiencies of iron and erythropoietin are common in the critically ill (Boshuizen et al., 2018).”
From Iron in infection and immunity (2020) · cites this paper as Boshuizen et al., 2018
The Background explains that inflammation can reduce iron availability for erythropoiesis without causing absolute iron deficiency, supporting the functional iron-deficiency part of the claim. It mentions erythropoietin treatment but does not say that functional erythropoietin deficiency is common in critically ill patients. (LLM, conf=0.87)
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References 46 · Cited by 39
- Authors
- Boshuizen, M., Binnekade, J. M., Nota, B., van de Groep, K., Cremer, O. L., Tuinman, P. R., Horn, J., Schultz, M. J., van Bruggen, R., Juffermans, N. P., de Beer, F. M., Bos, L. D. J., Glas, G. J., van Hooijdonk, R. T. M., Schouten, L. R. A., Straat, M., Witteveen, E., Wieske, L., Hoogendijk, A. J., Huson, M. A., Scicluna, B. P., van der Poll, T., van Vught, L. A., Wiewel, M. A., Bonten, M. J. M., Frencken, J. F., Klein Klouwenberg, P. M. C., Koster-Brouwer, M. E., Ong, D. S. Y., & Verboom, D. M.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- University Medical Center Utrecht (NL)
- University of Amsterdam (NL)
- Corresponding author
- Boshuizen, Margit
- ORCID
- Boshuizen, Margit
- Nota, Benjamin
- Cremer, Olaf L.
- Tuinman, Pieter R.
- Horn, Janneke
- Schultz, Marcus J.
- Juffermans, Nicole P.
- Bos, Lieuwe D.J.
- Glas, Gerie J.
- Schouten, Laura R.A.
- Witteveen, Esther
- Wieske, Luuk
- Hoogendijk, Arie J.
- Scicluna, Brendon P.
- Wiewel, Maryse A.
- Bonten, Marc J.M.
- Frencken, Jos F.
- Ong, David S.Y.
- Verboom, Diana M.
- Venue
- Annals of Intensive Care
- Publisher
- Elsevier BV
- Published
- 2018
- Volume
- 8
- Issue
- 1
- Pages
- 56
- ISSN
- 2110-5820 (ISSN-L)
- PMC
- PMC5930297
- OpenAlex
- W2807517476
- Cited by
- 39
- References
- 46
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 3 · 2022: 1 · 2021: 9 · 2020: 6 · 2019: 2 · 2018: 3
- FWCI
- 3.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Intensive Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Funders
- Sanquin (PPOP-14-31)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- anemia of chronic disease, iron metabolism, critically ill patients, sepsis, hepcidin, ferritin, interleukin-6, erythroferrone, transferrin, transferrin saturation, iron deficiency, inflammatory cytokines
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