title: Estimating iron overload in patients with suspected liver disease and elevated serum ferritin.
abstract: BACKGROUND
  Iron status evaluation in patients with suspected liver disease and elevated serum ferritin is often challenging because hyperferritinemia does not always indicate iron overload. A reliable approach to estimate iron overload without exposing the patient to unnecessary investigations would help the clinician to identify patients who may take advantage of iron-removal therapy.
  
  
  METHODS
  We analyzed all liver biopsies, including measurement of hepatic iron concentration, performed at the University Hospital Zurich from 1997 to 2010 to identify clinical and laboratory predictors of iron overload in patients with elevated serum ferritin (n = 147).
  
  
  RESULTS
  Hyperferritinemia was predictive of iron overload only in patients with a high level of serum ferritin (>2000 μg/L). In patients with moderate hyperferritinemia, liver transaminases inversely correlated with hepatic iron concentration. A combination of both parameters expressed as ferritin/aspartate transaminase ratio was highly predictive of tissue iron overload (sensitivity 83.3%, specificity 78.6%). Receiver operating characteristic analysis resulted in an area under the curve of 0.83.
  
  
  CONCLUSIONS
  We established a simple and reliable method to correctly estimate iron overload in patients with suspected liver disease and elevated serum ferritin.
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Switzerland.
authors.forename: Pietro E
authors.initials: PE
authors.lastname: Cippà
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Switzerland.
authors.forename: Irena
authors.initials: I
authors.lastname: Boucsein
authors.affiliation: Division of Pathology, University Hospital Zurich, Switzerland.
authors.forename: Heiner
authors.initials: H
authors.lastname: Adams
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Switzerland. Electronic address: pierre-alexandre.krayenbuehl@spital-linth.ch.
authors.forename: Pierre-Alexandre
authors.initials: PA
authors.lastname: Krayenbuehl
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007501:Iron / Q000378:metabolism; D019190:Iron Overload / Q000097:blood / Q000175:diagnosis*; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013557:Switzerland
chemical_list: D005293:Ferritins; D007501:Iron; D001219:Aspartate Aminotransferases
keywords: Ferritin; Iron metabolism; Iron overload