Ferritin as prognostic marker in COVID-19: the FerVid study.

Para, Ombretta; Caruso, Lorenzo; Pestelli, Giulia; Tangianu, Flavio; Carrara, Davide; Maddaluni, Lucia; Tamburello, Antonio; Castelnovo, Laura; Fedi, Giacomo; Guidi, Stefano; Pestelli, Caterina; Pennella, Benedetta; Ciarambino, Tiziana; Nozzoli, Carlo; Dentali, Francesco

BACKGROUND In COVID-19 patients the progressive clinical deterioration seems secondary to the activation of a cytokine storm. Ferritin is considered a direct mediator of the immune system and some evidences suggested a shared physio-pathogenic basis between COVID-19 and "Hyperferritinemic Syndromes". The aim of our study was to evaluate the prognostic role of ferritin in COVID-19 patients. METHODS We retrospectively studied consecutive COVID-19 patients admitted to 4 Italian Internal Medicine Units. Role of potential prognostic markers was evaluated with binary logistic regression analysis and results were expressed as odds ratios (ORs) with the corresponding 95% confidence intervals (CIs). Poor outcome was defined as death or need to transfer in the intensive care unit. RESULTS Two hundred patients were included (mean age 68.75 ± 13.22 years). Ferritin value was ​​highly elevated (> 3000 ng/mL) in 8% of our population; 13% of patients were transferred to intensive care units and 12% of patients died. At multivariate analysis, highly elevated ferritin levels (OR 16.67 C.I. 4.89 - 57.57 p<0.001) and hemoglobin < 10 g/dL (OR 8.88 C.I. 2.02 - 39.09 p=0.004) were independently associated with a bad outcome. Patients with ferritin values > 3000 ng/ml appeared to have an inflammatory activation with elevated values of CRP and D-dimer and low values of lymphocyte count. CONCLUSION Our results confirm the prognostic role of ferritin in hospitalized COVID-19 patients. Patients with high ferritin levels should be considered critically-ill and treated in an adequate setting. Furthermore, COVID-19 seems to share some characteristics with hyperferritinemic syndromes with potential therapeutic implications.