Intensive care medicine

2019-20 coronavirus outbreak

Sepsis

Cohort

Virology

Cohort study

Hemoglobin

Anemia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Outbreak

Ferritin

Coronavirus disease 2019 (COVID-19)

Physiology

Serum iron

Procalcitonin

Inflammation

Infectious disease (medical specialty)

Internal medicine

Medicine

Gastroenterology

Disease

Hepcidin

HemaSphere

Iron metabolism might play a crucial role in cytokine release syndrome in COVID‐19 patients. Therefore, we assessed iron metabolism markers in COVID‐19 patients for their ability to predict disease severity. COVID‐19 patients referred to the Heidelberg University Hospital were retrospectively analyzed. Patients were divided into outpatients (cohort A, n = 204), inpatients (cohort B, n = 81), and outpatients later admitted to hospital because of health deterioration (cohort C, n = 23). Iron metabolism parameters were severely altered in patients of cohort B and C compared to cohort A. In multivariate regression analysis including age, gender, CRP and iron‐related parameters only serum iron and ferritin were significantly associated with hospitalization. ROC analysis revealed an AUC for serum iron of 0.894 and an iron concentration &lt;6 μmol/l as the best cutoff‐point predicting hospitalization with a sensitivity of 94.7% and a specificity of 67.9%. When stratifying inpatients in a low‐ and high oxygen demand group serum iron levels differed significantly between these two groups and showed a high negative correlation with the inflammatory parameters IL‐6, procalcitonin, and CRP. Unexpectedly, serum iron levels poorly correlate with hepcidin. We conclude that measurement of serum iron can help predicting the severity of COVID‐19. The differences in serum iron availability observed between the low and high oxygen demand group suggest that disturbed iron metabolism likely plays a causal role in the pathophysiology leading to lung injury.

Hypoferremia is Associated With Increased Hospitalization and Oxygen Demand in COVID‐19 Patients