title: Does IV Iron Induce Plasma Oxidative Stress in Critically Ill Patients? A Comparison With Healthy Volunteers.
abstract: OBJECTIVE
  To compare the oxidative stress induced by IV iron infusion in critically ill patients and in healthy volunteers.
  
  
  METHODS
  Multicenter, interventional study.
  
  
  METHODS
  Two ICUs and one clinical research center.
  
  
  METHODS
  Anemic critically ill patients treated with IV iron and healthy volunteers.
  
  
  METHODS
  IV infusion of 100 mg of iron sucrose.
  
  
  RESULTS
  Thirty-eight anemic patients (hemoglobin, median [interquartile range] = 8.4 g/dL [7.7-9.2]) (men, 25 [66%]; aged 68 yr [48-77]; Simplified Acute Physiology Score II, 48.5 [39-59]) and 39 healthy volunteers (men, 18 [46%]; aged 42.1 yr [29-50]) were included. Blood samples were drawn before (H0) and 2, 6, and 24 hours (H2, H6, and H24) after a 60-minute iron infusion for the determination of nontransferrin bound iron, markers of lipid peroxidation-8α-isoprostanes, protein oxidation-advanced oxidized protein product, and glutathione reduced/oxidized. Iron infusion had no effect on hemodynamic parameter in patients and volunteers. At baseline, patients had much higher interleukin-6, C-reactive protein, and hepcidin levels. 8α-isoprostanes was also higher in patients at baseline (8.5 pmol/L [6.5-12.9] vs 4.6 pmol/L [3.5-5.5]), but the area under the curve above baseline from H0 to H6 was not different (p = 0.38). Neither was it for advanced oxidized protein product and nontransferrin bound iron. The area under the curve above baseline from H0 to H6 (glutathione reduced/oxidized) was lower in volunteers (p = 0.009). Eight patients had a second set of dosages (after the fourth iron infusion), showing higher increase in 8α-isoprostanes.
  
  
  CONCLUSIONS
  In our observation, IV iron infusion does not induce more nontransferrin bound iron, lipid, or protein oxidation in patients compared with volunteers, despite higher inflammation, oxidative stress, and hepcidin levels and lower antioxidant at baseline. In contrary, iron induces a greater decrease in antioxidant, compatible with higher oxidative stress in volunteers than in critically ill patients.
authors.affiliation: 1Département Anesthésie Réanimation, CHU Angers, LUNAM Université d'Angers, Angers, France.2Service d'Anesthésie-Réanimation, AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Paris, France.3INSERM, IAME, UMR 1137, Paris, France.4Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.5Service de Biostatistique, AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Paris, France.6INSERM U1149, Centre de Recherche sur l'inflammation, Paris, France.7Laboratory of Excellence, GR-Ex, Paris, France.8INSERM CIC 1425, AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Paris, France.9INSERM, UMR1152, Paris, France.
authors.forename: Sigismond
authors.initials: S
authors.lastname: Lasocki
authors.forename: Pascale
authors.initials: P
authors.lastname: Piednoir
authors.forename: Camille
authors.initials: C
authors.lastname: Couffignal
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rineau
authors.forename: Guillaume
authors.initials: G
authors.lastname: Dufour
authors.forename: Thibaud
authors.initials: T
authors.lastname: Lefebvre
authors.forename: Herve
authors.initials: H
authors.lastname: Puy
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.forename: Fathi
authors.initials: F
authors.lastname: Driss
authors.forename: Clementine
authors.initials: C
authors.lastname: Schilte
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy; D000975:Antioxidants / Q000627:therapeutic use; D019540:Area Under Curve; D002097:C-Reactive Protein; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D005290:Ferric Compounds / Q000097:blood / Q000627:therapeutic use*; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid / Q000097:blood / Q000627:therapeutic use*; D064368:Healthy Volunteers; D006801:Humans; D007262:Infusions, Intravenous; D015850:Interleukin-6; D015227:Lipid Peroxidation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects*
chemical_list: D000975:Antioxidants; D005290:Ferric Compounds; D015850:Interleukin-6; D002097:C-Reactive Protein; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid