title: Serum hepcidin and ferritin to iron ratio in evaluation of bacterial versus viral infections in children: a single-center study.
abstract: BACKGROUND
  Differential diagnosis of childhood infections is important. Several biochemical indices steer diagnosis toward bacterial agents, although the data are often not definitive. Hepcidin is a central component of blood iron, and ferritin alterations occur during infections. We measured hepcidin changes and evaluated ferritin to iron ratio (FIR) in patients with suspected infections.
  
  
  METHODS
  We studied 69 children with infection and an equal number of matched controls during a 3-year period. A bacterial agent was demonstrated in 17 and a viral pathogen in 52 of the patients. Hematologic and biochemical tests were performed on all children including ferritin, iron and hepcidin. FIR was calculated and receiver operating characteristic curve analysis was performed to evaluate the best FIR cutoff value to discriminate between patients and controls and between patients with bacterial infections and viral infections.
  
  
  RESULTS
  Hepcidin, ferritin and FIR were significantly higher and iron values significantly lower in febrile patients than its controls. Patients with bacterial infection had significantly lower iron and higher FIR than those with viral infection. FIR had high accuracy discriminating patients from controls but only moderate accuracy discriminating bacterial from viral infected patients.
  
  
  CONCLUSIONS
  If further studies with larger samples confirm these observations, FIR could be used as an inexpensive, rapid and easily performed complementary index for diagnosis of bacterial infections.
authors.affiliation: Second Department of Pediatrics, 'P&A Kyriakou' Children's Hospital, Medical School, Athens, Greece. lydiakossiva@hotmail.com
authors.forename: Lydia
authors.initials: L
authors.lastname: Kossiva
authors.forename: Dimitrios I
authors.initials: DI
authors.lastname: Gourgiotis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Tsentidis
authors.forename: Theodora
authors.initials: T
authors.lastname: Anastasiou
authors.forename: Antonis
authors.initials: A
authors.lastname: Marmarinos
authors.forename: Helen
authors.initials: H
authors.lastname: Vasilenko
authors.forename: Triantafyllia
authors.initials: T
authors.lastname: Sdogou
authors.forename: Helen
authors.initials: H
authors.lastname: Georgouli
mesh_terms: D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D019540:Area Under Curve; D001424:Bacterial Infections / Q000097:blood* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood*; D064451:Hepcidins; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood*; D008297:Male; D012372:ROC Curve; D014777:Virus Diseases / Q000097:blood* / Q000175:diagnosis
chemical_list: D023181:Antimicrobial Cationic Peptides; C578702:HAMP protein, human; D064451:Hepcidins; D005293:Ferritins; D007501:Iron