ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2019 December;85(12):1289-98

DOI: 10.23736/S0375-9393.19.13534-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Elevated ferritin and soluble CD25 in critically ill patients are associated with parameters of (hyper) inflammation and lymphocyte cytotoxicity

Tatiana von BAHR GREENWOOD ^{1, 2} ✉, Kajsa PALMKVIST-KAIJSER ^{1, 2}, Samuel C. CHIANG ³, Bianca TESI ^{1, 4, 5}, Yenan T. BRYCESON ³, Hans HJELMQVIST ⁶, Jan-Inge HENTER ^{1, 2}

¹ Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; ² Theme of Children’s and Women’s Health, Karolinska University Hospital, Stockholm, Sweden; ³ Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; ⁴ Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden; ⁵ Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; ⁶ Division of Anesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

BACKGROUND: Critically ill patients may develop a potentially fatal hyperinflammatory condition known as secondary (acquired) hemophagocytic lymphohistiocytosis (sHLH), the cause of which is unclear. We evaluated serum ferritin and soluble CD25 (sCD25) in critically ill patients, and their association with other parameters of inflammation and critical illness. Moreover, aiming to better understand the pathogenesis of sHLH, we also evaluated lymphocyte cytotoxicity parameters and correlations with the inflammatory markers ferritin and sCD25.
METHODS: In a prospective observational study, 32 patients with ferritin ≥500 µg/L (24 with sepsis) were studied on admission to an intensive care unit (ICU) with regard to ferritin and corresponding clinical and laboratory features including sCD25, and detailed lymphocyte cytotoxicity and genetic analyses whenever possible.
RESULTS: Critically ill patients had elevated, positively correlated levels of serum ferritin and sCD25 (rs=0.465, P=0.008); both associated with other risk factors of poor outcome in critically ill, such as thrombocytopenia (rs=-0.534, P=0.002 and rs=-0.421, P=0.018, respectively), and sCD25 with hypoalbuminemia (rs=-0.678, P<0.001) and life support treatments (rs=0.479, P=0.006). Interestingly, ferritin levels were inversely associated with natural killer (NK)-cell cytotoxicity (rs=-0.462, P=0.047) and degranulation (rs=-0.504, P=0.030). Moreover, of four patients with abnormally low cytotoxicity, three (75%) had <5% circulating NK-cells.
CONCLUSIONS: Our study suggests that hyperferritinemia and sCD25 correlate with other laboratory parameters indicative of severe hyperinflammation and organ dysfunction in critically ill ICU-patients, indicating their value in identifying hyperinflammatory critically ill patients for early intervention. Furthermore, it suggests that hyperferritinemia and hyperinflammation may partly be associated with a low percentage circulating NK-cells, and hence, the associated low lymphocyte cytotoxicity.

KEY WORDS: Ferritins; Inflammation; Lymphohistiocytosis, hemophagocytic; Critical illness; Sepsis