title: Serum hepcidin-25 in comparison to biochemical markers and hematological indices for the differentiation of iron-restricted erythropoiesis.
abstract: BACKGROUND
  Biochemical markers have problems in distinguishing iron deficiency anemia (IDA) from anemia of chronic disease (ACD), and the combined state of iron-restricted erythropoiesis (IRE) with ACD (ACD/IRE). We investigated the extent to which hepcidin-25, a potential marker for the evaluation of iron metabolism, enables the differentiation of the states above, and to assess its correlation with convential markers of iron deficiency.
  
  
  METHODS
  One hundred and fifty-five patients with anemia were classified as having IDA, ACD or ACD/IRE using clinical findings, biochemical markers and hematological indices. The diagnostic performance of hepcidin-25 alone or in combination with the reticulocyte hemoglobin content (CHr) was evaluated using receiver-operating characteristic curve analysis and multivariate analysis. Hepcidin-25 was determined using an isotope-dilution micro-HPLC-tandem mass spectrometry method.
  
  
  RESULTS
  Hepcidin-25 correlated with biochemical markers of iron deficiency but not with hematological indices. Use of a hepcidin-25 cut-off of ≤ 4 nmol/L allowed the differentiation of IDA from ACD and ACD/IRE, but not the discrimination of ACD from ACD/IRE in patients with severe inflammation. Furthermore, the discrimination of ACD/IRE from ACD required the combination with CHr.
  
  
  CONCLUSIONS
  Hepcidin-25 is primarily an indicator for decreased body iron levels, but not for IRE. The combination of hepcidin-25 with CHr in a diagnostic plot (hepcidin-25 plot) might be useful for the differentiation of ACD from ACD/IRE and IDA.
authors.affiliation: Klinik und Poliklinik für Urologie, Johannes-Guttenberg University, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Thomas
authors.forename: Uwe
authors.initials: U
authors.lastname: Kobold
authors.forename: Lothar
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000150:complications; D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D004920:Erythropoiesis; D005260:Female; D006403:Hematologic Tests; D064451:Hepcidins; D006801:Humans; D007249:Inflammation / Q000150:complications; D000090463:Iron Deficiencies; D008297:Male
chemical_list: D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D064451:Hepcidins; C545475:hepcidin 25, human