title: Serum ferritin predicts early mortality in patients with decompensated cirrhosis.
abstract: OBJECTIVE
  Serum ferritin is a known marker of hepatic necro-inflammation and has been studied to predict 1 year mortality and post-transplant survival in decompensated cirrhotics. However, there are no studies evaluating ferritin as a predictor of early mortality. We investigated whether serum ferritin levels could predict 15 day and 30 day mortality in patients with decompensated cirrhosis.
  
  
  METHODS
  318 patients with decompensated cirrhosis were included.
  
  
  RESULTS
  Patients of decompensated cirrhosis [257 males, mean age of 51 [±13]years, were followed for a median of 31 days. Serum ferritin levels were significantly different between survivors and non-survivors [p<0.001] and showed significant correlation with MELD score [p<0.001], CTP score [p<0.001], leucocyte counts [TLC] [p<0.001], serum sodium [p<0.001], ACLF grades [p=0.005], spontaneous bacterial peritonitis [SBP] [p=0.02], hepatic encephalopathy [HE] [p<0.001] and hepatorenal syndrome [HRS] [p=0.012]. Serum ferritin, etiology, MELD, HE, CTP score, sodium, TLC, and ACLF grades were significant predictors of mortality on univariate analysis. Ferritin [p=0.04, HR 1.66 95% CI (1.02-2.73)] was a significant predictor of early mortality on multivariate analysis along with HE [p=0.006, HR 3.47 95% CI (2.13-8.41)] (Model 1), TLC [p=0.02, HR 1.81 95% CI (1.06-3.07)] (Model 2), ACLF grades [p=0.018, HR 2.013,95% CI (1.126-3.60)], and CTP score [p<0.0001, HR 1.36 95% CI (1.17-1.59)] (Model 3).
  
  
  CONCLUSIONS
  Serum ferritin levels correlate with severity of hepatic decompensation and are associated with early liver related death independent of the MELD score in hospitalized patients with decompensated cirrhosis. This could also have a potential therapeutic implication.
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Maiwall
authors.affiliation: Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Chaudhary
authors.affiliation: Department of Research, Institute of Liver and Biliary Sciences, Delhi, India.
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Maras
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Wani
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India.
authors.forename: Chandan
authors.initials: C
authors.lastname: Kumar
authors.affiliation: Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: C
authors.initials: C
authors.lastname: Bihari
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India.
authors.forename: Chitranshu
authors.initials: C
authors.lastname: Vashisht
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India. Electronic address: shivsarin@gmail.com.
authors.forename: S K
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D005293:Ferritins
keywords: Decompensated cirrhosis; Ferritin; Hyperferritinemia; Mortality; Portal hypertension