title: Serum ferritin is a biomarker for liver mortality in the Hemochromatosis and Iron Overload Screening Study.
abstract: BACKGROUND
  We identified no reports of long-term follow-up of participants in hemochromatosis screening programs. We evaluated causes of death and survival in non-C282Y homozygous Canadian participants in the primary care-based hemochromatosis and iron overload screening (HEIRS) study.
  
  
  METHODS
  Initial screening (IS) included transferrin saturation (TS), serum ferritin (SF), HFE genotyping (C282Y, H63D), and health questionnaire responses. By definition, participants without C282Y or H63D had HFE wt/wt. We linked 20,306 Canadian participants to the Ontario Death Registry for dates and causes of death 9 y after IS. We computed Cox proportional hazards to identify factors with increased death risks and Kaplan-Meier curves to estimate survival of non-C282Y homozygous participants with SF ≤ 1,000 μg/L and > 1,000 μg/dL.
  
  
  RESULTS
  There were 19,052 evaluable participants (IS mean age 49 y; 60% women; 93 C282Y homozygotes). There were 988 deaths. Significantly increased hazard ratios for all-cause mortality were positively associated with TS, SF, men, and C282Y homozygosity, and liver disease, diabetes, and heart failure reports. Non-C282Y homozygous participants with SF > 1,000 μg/L had lower survival than those with SF ≤ 1,000 μg/L (p < 0.0001).
  
  
  CONCLUSIONS
  Nine years after initial screening, non-C282Y homozygous participants and SF > 1,000 μg/L was associated with decreased survival.
authors: Department of Medicine, Western University, London, Ontario, Canada.
authors: Paul C
authors: PC
authors: Adams
authors: Southern Iron Disorders Center, Birmingham, Alabama and Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: James C
authors: JC
authors: Barton
authors: nstitute of Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.
authors: Helen
authors: H
authors: Guo
authors: Institute of Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.
authors: David
authors: D
authors: Alter
authors: Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
authors: Mark
authors: M
authors: Speechley
mesh_terms: D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D005260:Female; D005293:Ferritins / Q000097:blood*; D006432:Hemochromatosis / Q000097:blood* / Q000401:mortality; D006801:Humans; D019190:Iron Overload / Q000097:blood* / Q000401:mortality; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D005293:Ferritins