Graham, F. J., Pellicori, P. , Masini, G., Cuthbert, J. J., Clark, A. L. and Cleland, J. G.F. (2023) Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure. ESC Heart Failure, (doi: 10.1002/ehf2.14438) (PMID:37400990) (Early Online Publication)
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Abstract
Aims: Transferrin saturation (TSAT), a marker of iron deficiency, reflects both serum concentrations of iron (SIC) and transferrin (STC). TSAT is susceptible to changes in each of these biomarkers. Little is known about determinants of STC and its influence on TSAT and mortality in patients with heart failure. Accordingly, we studied the relationship of STC to clinical characteristics, to markers of iron deficiency and inflammation and to mortality in chronic heart failure (CHF). Methods and results: Prospective cohort of patients with CHF attending a clinic serving a large local population. A total of 4422 patients were included (median age 75 (68–82) years; 40% women; 32% with left ventricular ejection fraction ≤40%). STC ≤ 2.3 g/L (lowest quartile) was associated with older age, lower SIC and haemoglobin and higher high-sensitivity C-reactive protein, ferritin and N-terminal pro-brain natriuretic peptide compared with those with STC > 2.3 g/L. In the lowest STC quartile, 624 (52%) patients had SIC ≤13 μmol/L, of whom 38% had TSAT ≥20%. For patients in the highest STC quartile, TSAT was <20% when SIC was >13 μmol/L in 185 (17%) patients. STC correlated inversely with ferritin (r = −0.52) and high-sensitivity C-reactive protein (r = −0.17) and directly with albumin (r = 0.29); all P < 0.001. In models adjusted for age, N-terminal pro-brain natriuretic peptide and haemoglobin, both higher SIC (hazard ratio 0.87 [95% CI: 0.81–0.95]) and STC (hazard ratio 0.82 [95% CI: 0.73–0.91]) were associated with lower mortality. SIC was more strongly associated with both anaemia and mortality than either STC or TSAT. Conclusions: Many patients with CHF and a low STC have low SIC even when TSAT is >20% and serum ferritin >100 μg/L; such patients have a high prevalence of anaemia and a poor prognosis and might have iron deficiency but are currently excluded from clinical trials of iron repletion.
| Item Type: | Articles |
|---|---|
| Status: | Early Online Publication |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Masini, Dr Gabriele and Graham, Dr Fraser and Cleland, Professor John and Pellicori, Dr Pierpaolo |
| Authors: | Graham, F. J., Pellicori, P., Masini, G., Cuthbert, J. J., Clark, A. L., and Cleland, J. G.F. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | ESC Heart Failure |
| Publisher: | Wiley |
| ISSN: | 2055-5822 |
| ISSN (Online): | 2055-5822 |
| Published Online: | 03 July 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in ESC Heart Failure 2023 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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