Transferrin Saturation and Serum Ferritin Are Main Predictors of Liver Iron Content in Subjects With Hyperferritinemia.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Giulia Risca, Sara Pelucchi, Raffaella Mariani, Mara Botti, Giulia Capitoli, Filiberto Di Gennaro, Stefania Galimberti, Alberto Piperno
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Abstract

Background and aims: Hyperferritinemia is widespread and is caused by or associated with a variety of diseases requiring complex diagnostic workup. Magnetic resonance imaging-based liver iron quantification (LICMRI) can differentiate subjects with iron overload requiring treatment but is still limited to specialized centers and costly. We aimed to determine whether parameters belonging to the diagnostic setting of hyperferritinemia could lead to a more selective use of LICMRI.

Methods: We enrolled a cohort of 570 subjects with hyperferritinemia from a tertiary hospital center. They underwent full clinical and laboratory evaluation, and LICMRI. We applied a partitioning tree to explore which features were relevant in classifying LICMRIseverity from grade 1 to 3.

Results: A total of 66.1% had LICMRI≤3 mg/g (grade 1), while 11.2% had LICMRI above 7 mg/g (grade 3). The partitioning tree model showed a global accuracy of 78% (95% confidence interval, 74%-81%) in predicting the severity of LICMRI in the entire series. Sensitivity and specificity were high to distinguish patients with grade 1 from those with grade 3 but not from patients with grade 2. Focusing on the LICMRI threshold of 7 mg/g, we found that transferrin saturation (TSAT) ≥60% and TSAT <60% with serum ferritin ≥963 μg/L correctly classified 61 (95.3%) subjects with grade 3 LICMRI to class 3. Based on these cutoffs, 193 subjects with LICMRI grade 1 and 2 were also selected for LICMRI assessment, while 316 patients (55.4%) would be addressed to follow-up.

Conclusions: TSAT and serum ferritin allow us to identify more than 95% of patients with a LICMRI grade 3 and reduce MRI requirements by more than 50%.

铁蛋白饱和度和血清铁蛋白是高铁血症患者肝铁含量的主要预测指标。
背景和目的:高铁蛋白血症广泛存在,由多种疾病引起或与之相关,需要复杂的诊断检查。基于核磁共振成像的肝铁定量(LICMRI)可以区分需要治疗的铁超载患者,但仍然局限于专门的中心和昂贵的。我们的目的是确定属于高铁蛋白血症诊断设置的参数是否会导致更有选择性地使用LICMRI。方法:我们从一家三级医院中心招募了570名高铁素血症患者。他们接受了全面的临床和实验室评估,以及LICMRI。我们应用分区树来探索哪些特征与LICMRI的分类相关,严重程度从1级到3级。结果:66.1%的患者licmrrimri≥7 mg/g(3级)。分区树模型在预测整个系列的LICMRI严重程度方面显示出78% (95%CI=74-81%)的全局准确性。区分1级和3级患者的敏感性和特异性较高,但区分2级患者的敏感性和特异性较低。以7 mg/g的LICMRI阈值为中心,我们发现tsat0 60%和TSAT963 μg/L正确地将61例(95.3%)LICMRI 3级受试者划分为3级。基于这些截断值,193例LICMRI 1级和2级患者也被选择进行LICMRI评估,316例(55.4%)患者将进行随访。结论:TSAT和血清铁蛋白使我们能够识别95%以上的LICMRI 3级患者,并将MRI要求降低50%以上。
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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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