title: Serum ferritin as a predictor of treatment outcome in patients with chronic hepatitis C.
abstract: OBJECTIVE
  Antiviral treatment in chronic hepatitis C (CHC) involves ribavirin, a hemolytic agent. We planned a prospective study to evaluate whether drug-induced iron perturbation is clinically relevant as it relates to therapeutic outcome.
  
  
  METHODS
  Iron variables were sequentially assessed in 206 CHC patients undergoing antiviral therapy and were correlated with pretreatment iron status and histology, hemolysis, and therapeutic outcome.
  
  
  RESULTS
  At week 1 of therapy, serum iron (SI), transferrin saturation (TS), and serum ferritin (SF) increased markedly in all patients. All iron parameters correlated with hemolysis up to week 4; this correlation was lost for SF at later time points. SF rise during treatment was inversely related to baseline SF and iron deposits in hepatic mesenchymal/Kupffer cells. Both baseline SF and mesenchymal iron significantly correlated with fibrosis at multivariate analysis (P=0.015 and 0.008, respectively). Interestingly, baseline SF, despite good specificity (89%), had low sensitivity in predicting siderosis (25%). During therapy, SI, TS, and hemolysis parameters did not correlate with sustained virological response (SVR), whereas SF rise became an independent predictor of therapeutic response: a 2.5-fold increase of SF at week 12 associated with higher likelihood of SVR (odds ratio 1.91, P=0.032). Accordingly, lack of mesenchymal iron deposits at the baseline biopsy correlated with SVR (odds ratio 3.02, P=0.043).
  
  
  CONCLUSIONS
  In CHC, SF is a useful marker for assessing disease duration and progression before starting treatment and for predicting therapeutic response while on therapy. SF rise during antiviral therapy is largely independent of hemolysis and likely indicates activation of macrophages in response to antivirals.
authors.affiliation: Department of Internal Medicine, Center for Hemochromatosis, University Hospital of Modena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferrara
authors.forename: Paolo
authors.initials: P
authors.lastname: Ventura
authors.forename: Alberto
authors.initials: A
authors.lastname: Vegetti
authors.forename: Maria
authors.initials: M
authors.lastname: Guido
authors.forename: Gianluca
authors.initials: G
authors.lastname: Abbati
authors.forename: Elena
authors.initials: E
authors.lastname: Corradini
authors.forename: Giovanna
authors.initials: G
authors.lastname: Fattovich
authors.forename: Carlo
authors.initials: C
authors.lastname: Ferrari
authors.forename: Mara
authors.initials: M
authors.lastname: Tagliazucchi
authors.forename: Anna
authors.initials: A
authors.lastname: Carbonieri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Orlandini
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.forename: Sara
authors.initials: S
authors.lastname: Boninsegna
authors.forename: Eliseo
authors.initials: E
authors.lastname: Minola
authors.forename: Giovanna
authors.initials: G
authors.lastname: Rizzo
authors.forename: Fabio
authors.initials: F
authors.lastname: Belussi
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.forename: Marco
authors.initials: M
authors.lastname: Massari
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pozzato
authors.forename: Stefania
authors.initials: S
authors.lastname: Bonetto
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Rovere
authors.forename: Carla
authors.initials: C
authors.lastname: Sardini
authors.forename: Athos
authors.initials: A
authors.lastname: Borghi
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Zeneroli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Toniutto
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Rossi
authors.forename: Antonello
authors.initials: A
authors.lastname: Pietrangelo
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005293:Ferritins / Q000097:blood*; D006461:Hemolysis / Q000187:drug effects; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D007501:Iron / Q000097:blood; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use; D014168:Transferrin / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D014168:Transferrin; D011092:Polyethylene Glycols; D012254:Ribavirin; D005293:Ferritins; D007501:Iron; C100416:peginterferon alfa-2a