Optimized serum ferritin prediction of iron overload in transfusion-dependent thalassemia: likelihood ratio and age-adjustment approach.

IF 1.5 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Annals of Saudi Medicine Pub Date : 2023-03-01 DOI:10.5144/0256-4947.2023.90

Lutfi Ali Kurban, Bashayer Khamis Almarri, Maitha Helal Alshamsi, Shahid Shehadeh Abdelrahman, Sara Ghumail Alwahshi, Qays Alhorani, Rizwan Syed, Omran Bakoush

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引用次数: 0

Abstract

Background: Early detection of iron overload in transfusion-dependent thalassemia (TDT) patients is critical to prevent complications and improve survival.

Objectives: Evaluate the utility of serum ferritin (SF) in the prediction of hepatic and myocardial iron overload (HIO and MIO) compared to T2*-MRI.

Design: Retrospective SETTINGS: Governmental hospitals.

Patients and methods: Patients with TDT who had T2*-MRI examinations between January 2016 to October 2019 were included. The predictive value of SF for detection of HIO and MIO was assessed by measuring area under the curve (AUC). A sample size of 123 cases was calculated to detect a correlation of 0.25 with 90% power and a two-sided type I error of 0.05.

Main outcome measures: The correlation between SF and estimated hepatic iron concentration.

Sample size: 137 TDT patients who required regular blood transfusions.

Results: The predictive value of SF was excellent for detection of HIO (AUC=0.83-0.87) but fair for detection of MIO (AUC=0.67). The two independent predictors of MIO were age and SF. The log of (age × SF) enhanced the SF predictive value for MIO (AUC=0.78). SF values of 700 and 1250 mg/L effectively excluded mild and moderate HIO with a sensitivity of 97.8% and 94.2%, respectively (LR-=0.1). While SF values of 1640 and 2150 mg/L accurately diagnosed mild and moderate HIO with a specificity of 95.55% and 96.4%, respectively (LR+>10). A log of (age × SF) cut-off value of 4.15 effectively excluded MIO (LR-=0.1), while a value of 4.65 moderately confirmed MIO (LR+=3.2).

Conclusions: SF is an excellent predictor of hepatic IO in TDT. Age adjustment enhanced its myocardial IO predictive accuracy. Likelihood ratio-based SF cut-off values may help clinicians in risk stratification and treatment decision-making.

Limitations: The laboratory data were gathered retrospectively and although the risk of selection bias for T2*-MRI examination is thought to be low, it cannot be ignored.

Conflict of interest: None.

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输血依赖性地中海贫血中铁超载的优化血清铁蛋白预测:似然比和年龄调整方法。

背景:输血依赖性地中海贫血(TDT)患者早期发现铁超载对预防并发症和提高生存率至关重要。目的:评价血清铁蛋白(SF)与T2*-MRI相比在预测肝脏和心肌铁超载(HIO和MIO)中的应用价值。设计:回顾性设置:政府医院。患者和方法:纳入2016年1月至2019年10月进行T2*-MRI检查的TDT患者。通过测量曲线下面积(AUC)评估SF对HIO和MIO检测的预测价值。计算123例的样本量，发现相关性为0.25，功率为90%，双侧I型误差为0.05。主要观察指标:SF与肝铁浓度的相关性。样本量:需要定期输血的TDT患者137例。结果:SF对HIO的预测价值较好(AUC=0.83 ~ 0.87)，对MIO的预测价值一般(AUC=0.67)。MIO的两个独立预测因子是年龄和SF。(年龄× SF)的对数增强了SF对MIO的预测值(AUC=0.78)。SF值为700 mg/L和1250 mg/L时，分别以97.8%和94.2%的灵敏度(LR =0.1)有效排除轻度和中度的HIO。而SF值为1640和2150 mg/L，诊断轻度和中度HIO的特异性分别为95.55%和96.4% (LR+>10)。log (age × SF)截断值4.15有效排除了MIO (LR-=0.1)，而4.65中度证实了MIO (LR+=3.2)。结论:SF是TDT患者肝脏IO的一个很好的预测指标。年龄调整提高了心肌IO预测的准确性。基于似然比的SF临界值可以帮助临床医生进行风险分层和治疗决策。局限性:实验室数据是回顾性收集的，尽管T2*-MRI检查的选择偏倚风险被认为很低，但不可忽视。利益冲突:无。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Saudi Medicine 医学-医学：内科

CiteScore

2.80

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.