Iron deficiency and short-term adverse events in patients with decompensated heart failure

Clin Res Cardiol. 2021 Aug;110(8):1292-1298. doi: 10.1007/s00392-021-01832-z. Epub 2021 Mar 15.

Abstract

Background: For patients with heart failure (HF), iron deficiency (ID) is a common therapeutic target. However, little is known about the utility of transferrin saturation (TSAT) or serum ferritin for risk stratification in decompensated HF (DHF) or the European Society of Cardiology's (ESC) current definition of ID (ferritin < 100 μg/L or TSAT < 20% if ferritin is 100-299 μg/L). We evaluated the association between these potential markers of ID and the risk of 30-day readmission for HF or death in patients with DHF.

Methods: We retrospectively included 1701 patients from a multicenter registry of DHF. Serum ferritin and TSAT were evaluated 24-72 h after hospital admission, and multivariable Cox regression was used to assess their association with the composite endpoint.

Results: Participants' median (quartiles) age was 76 (68-82) years, 43.8% were women, and 51.7% had a left ventricular ejection fraction > 50%. Medians for NT-proBNP, TSAT, and ferritin were 4067 pg/mL (1900-8764), 14.1% (9.0-20.3), and 103 ug/L (54-202), respectively. According to the current ESC definition, 1,246 (73.3%) patients had ID. By day 30, there were 177 (10.4%) events (95 deaths and 85 HF readmission). After multivariable adjustment, lower TSAT was associated with outcome (p = 0.009) but serum ferritin was not (HR 1.00; 95% confidence interval 0.99-1.00, p = 0.347).

Conclusions: Lower TSAT, but not ferritin, was associated with a higher risk of short-term events in patients with DHF. Further research is needed to confirm these findings and the utility of serum ferritin as a marker of ID in DHF.

Keywords: Acute heart failure; Ferritin; Iron deficiency; Prognosis; Transferrin saturation.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Female
  • Ferritins / blood*
  • Heart Failure / blood*
  • Humans
  • Iron Deficiencies / complications*
  • Male
  • Natriuretic Peptide, Brain / blood
  • Patient Readmission
  • Peptide Fragments / blood
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke Volume
  • Transferrins / blood*

Substances

  • Biomarkers
  • Peptide Fragments
  • Transferrins
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Ferritins