Association of serum iron profile with in-hospital mortality in adult patients with sepsis: A prospective observational study

Abstract

Objective: To investigate the association between derangement of the serum iron profile and in-hospital mortality of adult patients diagnosed with sepsis using Sepsis-3 criteria, and to assess its potential role in improving diagnostic and prognostic accuracy. Methods: This prospective observational study (May 2023-October 2024) was conducted in the emergency and medical ward. Serum iron profile and Sequential Organ Failure Assessment (SOFA) scores were assessed on admission. Clinical outcomes were tracked; associations with serum iron profile were determined using Student's t-test and chi-square test. Results: One hundred fifty adult Sepsis-3 patients were recruited. 58 Patients (38.7%) died during hospitalization. Mean ferritin for deceased patients was 929.0±310.0µg/L, and was significantly higher than 417.0±311.0µg/L for survivors (P<.001). A serum ferritin value of 700µg/L strongly predicted in-hospital mortality (69.9% mortality above this threshold). The odds ratio was 23.2 (95% CI: 9.2–58.3) for ferritin above 700µg/L, indicating likelihood of death 23.2 times higher in patients with serum ferritin above 700µg/L. With SOFA, the odds ratio was 3.7, highlighting ferritin as a stronger individual predictor. Conclusions: Serum ferritin level is an independent predictor of in-hospital mortality in sepsis. Monitoring ferritin levels can enhance early risk stratification, facilitate timely intervention, and improve outcomes.

Keywords

Sepsis / Serum iron / Ferritin / SOFA / Total iron binding capacity / Transferrin saturation

Conflict of interest statement

The authors report no conflict of interest.

Ethical statement

The study was approved by the Institutional Ethical Committee for Human Research of University College of Medical Sciences and GTB Hospital, University of Delhi (Approval number: IECHR-2023-59-54). All participants provided informed consent and participated voluntarily.

Funding

This study received no extramural funding.

Data availability statement

The data supporting the findings of this study are available from the corresponding authors upon request.

Authors’ contributions

BN conducted the literature review, patient/clinical work, data collection, analysis, and statistical evaluation; drafted the manuscript, revised it critically, and served as the guarantor of the study. SN conceived the study idea, developed the scientific framework, supported literature review, and critically revised the manuscript. AA contributed to study conceptualization and intellectual input and reviewed and revised the manuscript. RS supervised the study design, performed statistical analysis, and contributed to manuscript revision and final approval. MK participated in the clinical and experimental execution of the study. All authors approved the final manuscript for submission.

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