title: High serum ferritin is associated with worse outcome of patients with decompensated cirrhosis.
abstract: BACKGROUND
  Studies in patients with decompensated cirrhosis showed a correlation between serum ferritin levels and patients' prognosis. Besides, red blood cell distribution width (RDW) and mean platelet volume (MPV) have been associated with the severity of hepatic function. The aim of this study was to evaluate the prognostic impact of serum ferritin and RDW/MPV in the outcome [survival, death, or liver transplantation (LT)] of patients with stable decompensated cirrhosis.
  
  
  METHODS
  Consecutive adult patients with stable decompensated cirrhosis admitted to our department between September 2010 and February 2016 were included. Serum ferritin, RDW and MPV were recorded in every patient. They were followed up and their outcome (alive, death, or LT) was evaluated.
  
  
  RESULTS
  192 consecutive patients with stable decompensated cirrhosis (142 men, age 54.2±12 years); at the end of follow up [12 (range: 1-64) months] 62 patients remained alive and 130 died or underwent LT. In multivariate analysis, serum ferritin (HR 1.001, 95%CI 1.00-1.002, P=0.005) and GFR (HR 0.96, 95%CI 0.92-0.99, P=0.035) were the only independent factors significantly associated with the outcome. Ferritin had low discriminative ability (AUC: 0.61) to the outcome yielding a sensitivity and specificity of 85.3% and 44.2%, respectively, at the best cut-off point (>55 ng/mL), while patients with ferritin >55 ng/mL (n=145) had a worse outcome compared to those with ferritin ≤55 ng/mL (n=47) (log rank P=0.001). RDW and MPV were not associated with the outcome.
  
  
  CONCLUSIONS
  High serum ferritin, but not RDW/MPV, is associated with worse outcome in patients with established decompensated cirrhosis. However, further studies are needed to elucidate better this issue.
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Oikonomou
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Goulis
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Stergios
authors.initials: S
authors.lastname: Soulaidopoulos
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Areti
authors.initials: A
authors.lastname: Karasmani
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Doumtsis
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Tsioni
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Eudokia
authors.initials: E
authors.lastname: Mandala
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Akriviadis
authors.affiliation: 4 Department of Internal Medicine, Hippokration General Hospital, Medical School Aristotle University of Thessaloniki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Cholongitas
keywords: Ferritin; decompensated cirrhosis; mean platelet volume; outcome; red blood cell distribution width