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Thomas DC, Khan J, Ananthan S, Kalladka M. Systemic Factors Affecting Pain Management in Dentistry. Dent Clin North Am 2024; 68:725-737. [PMID: 39244253 DOI: 10.1016/j.cden.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
There are several factors that affect a patient's experience of pain. These include both local and systemic factors. The systemic factors that affect patients' dental and orofacial pain experience include, but not limited to, hormonal, nutritional, systemic infections, neurodegenerative, and autoimmune, among others. Comprehensive medical history is essential to delineate any possible systemic factors affecting pain experience. A thorough review of systems should form the foundation, since multiple factors can affect the prognosis of pain management. This would facilitate early recognition and trigger prompt referrals to the appropriate medical professionals. This helps to reduce the health care burden.
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Affiliation(s)
- Davis C Thomas
- Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA; Orofacial Pain and Temporomandibular Disorders, Eastman Institute of Oral Health, Rochester, NY 14620, USA
| | - Junad Khan
- Orofacial Pain and Temporomandibular Disorders, Eastman Institute of Oral Health, Rochester, NY 14620, USA
| | - Sowmya Ananthan
- Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA
| | - Mythili Kalladka
- Orofacial Pain and Temporomandibular Disorders, Eastman Institute of Oral Health, Rochester, NY 14620, USA.
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2
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Von Holle A. Assessment of iron status. Curr Opin Clin Nutr Metab Care 2024; 27:397-401. [PMID: 38847622 PMCID: PMC11370657 DOI: 10.1097/mco.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
PURPOSE OF REVIEW Iron is an essential trace element in human health that can be harmful at abnormal levels such as iron overload or deficiency. Measured iron status in the body can depend on health outcomes experienced by the individual and this can complicate its accurate assessment. This review will highlight recent research on iron assessment in the literature. RECENT FINDINGS Research on iron assessment within the past 18 months included some common themes spanning new methods and biomarkers, as well as existing problems in assessing iron deficiency and overload. Heterogeneity in associations between inflammation and iron levels are reflected across different inflammatory biomarkers. New methods relevant to low- and high-resource settings may improve assessment in tissues with iron deficiency and overload. Consensus papers outlined best practices when using MRI to assess iron status. Outside of newer methods, traditional serum markers are the subject of a call for updated guidance when assessing iron status. SUMMARY Research continues on the topic of iron assessment, underlying its complex metabolism in the body and resulting challenges in assessment. Current literature underscores progress to make iron assessment more accessible, improve existing methods, and update current assessment methods so they correspond with recent research to improve human health.
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Affiliation(s)
- Ann Von Holle
- National Institute of Environmental Health Sciences, Durham, North Carolina, USA
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Benotti PN, Kaberi-Otarod J, Wood GC, Gerhard GS, Still CD, Bistrian BR. Iron homeostasis in obesity and metabolic and bariatric surgery: a narrative review. Surg Obes Relat Dis 2024:S1550-7289(24)00737-8. [PMID: 39277530 DOI: 10.1016/j.soard.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/08/2024] [Accepted: 08/08/2024] [Indexed: 09/17/2024]
Abstract
Iron deficiency has been recognized as a potentially modifiable nutritional complication of metabolic and bariatric surgery (MBS) since prior to the turn of the century. Despite this, it remains the most common and clinically significant nutritional complication of this surgery with the potential to negate quality of life and the health benefits of surgical weight loss. This narrative review summarizes the current literature regarding iron deficiency as it relates to patients with severe obesity and those who undergo MBS. Advances in the clinical knowledge of iron homeostasis in severe obesity as a chronic disease, current diagnostic criteria for the diagnosis of iron deficiency in this patient population, the significance of preoperative iron deficiency, postoperative iron deficiency, and the status of supplementation and treatment will be reviewed with emphasis on gaps in knowledge and needed areas of further study.
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Affiliation(s)
- Peter N Benotti
- Center for Obesity and Metabolic Research, Geisinger Medical Center, Danville, PA.
| | | | - G Craig Wood
- Center for Obesity and Metabolic Research, Geisinger Medical Center, Danville, PA
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biology Temple University, School of Medicine, Philadelphia, PA
| | - Christopher D Still
- Center for Obesity and Metabolic Research, Geisinger Medical Center, Danville, PA
| | - Bruce R Bistrian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Ren X, Jiang Z, Liu F, Wang Q, Chen H, Yu L, Ma C, Wang R. Association of serum ferritin and all-cause mortality in AKI patients: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1368719. [PMID: 38938379 PMCID: PMC11208335 DOI: 10.3389/fmed.2024.1368719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/07/2024] [Indexed: 06/29/2024] Open
Abstract
Background Serum ferritin (SF) is clinically found to be elevated in many disease conditions, and our research examines serum ferritin in patients with acute kidney injury (AKI) and its implication on the risk of short-term mortality in AKI. Methods Data were extracted from the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2) database. Adult patients with AKI who had serum ferritin tested on the first day of ICU admission were included. The primary outcome was 28-day mortality. Kaplan-Meier survival curves and Cox proportional hazards models were used to test the relationship between SF and clinical outcomes. Subgroup analyses based on the Cox model were further conducted. Results Kaplan-Meier survival curves showed that a higher SF value was significantly associated with an enhanced risk of 28-day mortality, 90-day mortality, ICU mortality and hospital mortality (log-rank test: p < 0.001 for all clinical outcomes). In multivariate Cox regression analysis, high level of SF with mortality was significantly positive in all four outcome events (all p < 0.001). This result remains robust after adjusting for all variables. Subgroup analysis of SF with 28-day mortality based on Cox model-4 showed that high level of SF was associated with high risk of 28-day mortality in patients regardless of the presence or absence of sepsis (p for interaction = 0.730). Positive correlations of SF and 28-day mortality were confirmed in all other subgroups (p for interaction>0.05). Conclusion High level of SF is an independent prognostic predictor of 28-day mortality in patients with AKI.
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Affiliation(s)
- Xiaoxu Ren
- Department of Nephrology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong medicine and Health Key Laboratory of Emergency Medicine, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Zhiming Jiang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong medicine and Health Key Laboratory of Emergency Medicine, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Fen Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong medicine and Health Key Laboratory of Emergency Medicine, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Quanzhen Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong medicine and Health Key Laboratory of Emergency Medicine, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Hairong Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong medicine and Health Key Laboratory of Emergency Medicine, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Lifeng Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong medicine and Health Key Laboratory of Emergency Medicine, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Chaoqun Ma
- Department of Emergency Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Rong Wang
- Department of Nephrology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
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Halfon P, Penaranda G, Ringwald D, Retornaz F, Boissel N, Bodard S, Feryn JM, Bensoussan D, Cacoub P. Laboratory tests for investigating anemia: From an expert system to artificial intelligence. Pract Lab Med 2024; 39:e00357. [PMID: 38404528 PMCID: PMC10883828 DOI: 10.1016/j.plabm.2024.e00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024] Open
Abstract
Objective To compare the laboratory tests conducted in real-life settings for patients with anemia with the expected prescriptions derived from an optimal checkup. Methods A panel of experts formulated an "optimal laboratory test assessment" specific to each anemia profile. A retrospective analysis was done of the laboratory tests conducted according to the type of anemia (microcytic, normocytic or macrocytic). Using an algorithmic system, the laboratory tests performed in real-life practice were compared with the recommendations suggested in the "optimal laboratory test assessment" and with seemingly "unnecessary" laboratory tests. Results In the analysis of the "optimal laboratory test assessment", of the 1179 patients with microcytic anemia, 269 (22.8%) had had one of the three tests recommended by the expert system, and only 33 (2.8%) had all three tests. For normocytic anemia, 1054 of 2313 patients (45.6%) had one of the eleven recommended tests, and none had all eleven. Of the 384 patients with macrocytic anemia, 196 (51%) had one of the four recommended tests, and none had all four. In the analysis of "unnecessary laboratory tests", one lab test was unnecessarily done in 727/3876 patients (18.8%), i.e. 339 of 1179 (28.8%) microcytic, 171 of 2313 (7.4%) normocytic, and 217 of 384 (56.5 %) macrocytic anemias. Conclusion Laboratory investigations of anemia remain imperfect as more than half of the cases did not receive the expected tests. Analyzing other diagnostic domains, the authors are currently developing an artificial intelligence system to assist physicians in enhancing the efficiency of their laboratory test prescriptions.
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Affiliation(s)
- Philippe Halfon
- Pôle de Médecine Interne et Maladies infectieuses Hôpital Européen, 13000, Marseille, France
- Laboratoire Alphabio, 13000, Marseille, France
| | | | | | - Frederique Retornaz
- Pôle de Médecine Interne et Maladies infectieuses Hôpital Européen, 13000, Marseille, France
| | - Nicolas Boissel
- AP-HP, Service d'hématologie, Hôpital St Louis, Paris, France
| | - Sylvain Bodard
- Université Paris Cité, F-75006, Paris, France
- AP-HP, Service d’Imagerie Adulte, Hôpital Universitaire Necker - Enfants Malades, F-75015, Paris, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75006, Paris, France
| | | | - David Bensoussan
- Service de chirurgie vasculaire, Centre hospitalier, avenue des tamaris, 13100, Aix en Provence, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
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Pan J, Liao Y, Huang Q, Ji G, Dai R, Lin D. Associations between serum ferritin, iron, and liver transaminases in adolescents: a large cross-sectional study. NUTR HOSP 2023; 40:949-959. [PMID: 37534446 DOI: 10.20960/nh.04653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Introduction Introduction: few previous studies suggest that serum iron status may be associated with liver function, but the relevant evidence remains limited, especially in adolescents. Objective: we aimed to investigate the association between serum ferritin, iron, and liver transaminases in adolescents. Methods: a cross-sectional study including 3,404 adolescents aged 10-19 was performed based on the National Health and Nutrition Examination Survey. Weighted multivariate regression, subgroup analysis, and sensitivity analysis were used. Results: a total of 3,404 adolescents were eventually included. Serum ferritin and iron were positively correlated to alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The association between serum ferritin and ALT remained positive in all genders and races, but only remained positive in girls and several races between serum ferritin and AST. The positive correlations kept present among girls between serum iron and ALT, and also kept present among girls and non-Hispanic whites between serum iron and AST. Additionally, serum ferritin and iron were also positively correlated to elevated ALT and elevated AST using binary logistic regression analysis. After excluding the subjects with serum ferritin levels above the upper limit of normal, the main results remained the same basically. Conclusion: the present results add novel evidences about the associations between serum ferritin, iron, and liver transaminases, which requires more confirmatory studies.
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Affiliation(s)
- Jialong Pan
- Department of Pediatrics. The Sixth Affiliated Hospital of Guangzhou Medical University. Qingyuan People's Hospital. Guangzhou Medical University
| | - Yonghua Liao
- Department of Pediatrics. The Sixth Affiliated Hospital of Guangzhou Medical University. Qingyuan People's Hospital. Guangzhou Medical University
| | - Qing Huang
- Department of Pediatrics. The Sixth Affiliated Hospital of Guangzhou Medical University. Qingyuan People's Hospital. Guangzhou Medical University
| | - Guoye Ji
- Department of Pediatrics. The Sixth Affiliated Hospital of Guangzhou Medical University. Qingyuan People's Hospital. Guangzhou Medical University
| | - Rujun Dai
- Department of Pediatrics. The Sixth Affiliated Hospital of Guangzhou Medical University. Qingyuan People's Hospital. Guangzhou Medical University
| | - Dongyun Lin
- Department of Pediatrics. The Sixth Affiliated Hospital of Guangzhou Medical University. Qingyuan People's Hospital. Guangzhou Medical University
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Kontoghiorghes GJ. Iron Load Toxicity in Medicine: From Molecular and Cellular Aspects to Clinical Implications. Int J Mol Sci 2023; 24:12928. [PMID: 37629109 PMCID: PMC10454416 DOI: 10.3390/ijms241612928] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Iron is essential for all organisms and cells. Diseases of iron imbalance affect billions of patients, including those with iron overload and other forms of iron toxicity. Excess iron load is an adverse prognostic factor for all diseases and can cause serious organ damage and fatalities following chronic red blood cell transfusions in patients of many conditions, including hemoglobinopathies, myelodyspasia, and hematopoietic stem cell transplantation. Similar toxicity of excess body iron load but at a slower rate of disease progression is found in idiopathic haemochromatosis patients. Excess iron deposition in different regions of the brain with suspected toxicity has been identified by MRI T2* and similar methods in many neurodegenerative diseases, including Alzheimer's disease and Parkinson's disease. Based on its role as the major biological catalyst of free radical reactions and the Fenton reaction, iron has also been implicated in all diseases associated with free radical pathology and tissue damage. Furthermore, the recent discovery of ferroptosis, which is a cell death program based on free radical generation by iron and cell membrane lipid oxidation, sparked thousands of investigations and the association of iron with cardiac, kidney, liver, and many other diseases, including cancer and infections. The toxicity implications of iron in a labile, non-protein bound form and its complexes with dietary molecules such as vitamin C and drugs such as doxorubicin and other xenobiotic molecules in relation to carcinogenesis and other forms of toxicity are also discussed. In each case and form of iron toxicity, the mechanistic insights, diagnostic criteria, and molecular interactions are essential for the design of new and effective therapeutic interventions and of future targeted therapeutic strategies. In particular, this approach has been successful for the treatment of most iron loading conditions and especially for the transition of thalassemia from a fatal to a chronic disease due to new therapeutic protocols resulting in the complete elimination of iron overload and of iron toxicity.
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Affiliation(s)
- George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, 3, Ammochostou Street, Limassol 3021, Cyprus
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Capdevila X, Lasocki S, Duchalais A, Rigal JC, Mertl P, Ghewy P, Farizon F, Lanz T, Buckert A, Belarbia S, Trochu JN, Cacoub P. Perioperative Iron Deficiency in Patients Scheduled for Major Elective Surgeries: A French Prospective Multicenter Cross-Sectional Study. Anesth Analg 2023; 137:322-331. [PMID: 36881542 DOI: 10.1213/ane.0000000000006445] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND The management of perioperative iron deficiency is a component of the concept of patient blood management. The objective of this study was to update French data on the prevalence of iron deficiency in patients scheduled for major surgery. METHODS The CARENFER PBM study was a prospective cross-sectional study in 46 centers specialized in orthopedic, cardiac, urologic/abdominal, or gynecological surgery. The primary end point was the prevalence of iron deficiency at the time of surgery (D-1/D0) defined as serum ferritin <100 µg/L and/or transferrin saturation (TSAT) <20%. RESULTS A total of 1494 patients (mean age, 65.7 years; women, 49.3%) were included from July 20, 2021 to January 3, 2022. The prevalence of iron deficiency in the 1494 patients at D-1/D0 was 47.0% (95% confidence interval [CI], 44.5-49.5). At 30 days after surgery, the prevalence of iron deficiency was 45.0% (95% CI, 42.0-48.0) in the 1085 patients with available data. The percentage of patients with anemia and/or iron deficiency increased from 53.6% at D-1/D0 to 71.3% at D30 ( P < .0001), mainly due to the increase of patients with both anemia and iron deficiency (from 12.2% at D-1/D0 to 32.4% at D30; P < .0001). However, a treatment of anemia and/or iron deficiency was administered preoperatively to only 7.7% of patients and postoperatively to 21.7% (intravenous iron, 14.2%). CONCLUSIONS Iron deficiency was present in half of patients scheduled for major surgery. However, few treatments to correct iron deficiency were implemented preoperatively or postoperatively. There is an urgent need for action to improve these outcomes, including better patient blood management.
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Affiliation(s)
- Xavier Capdevila
- From the Department of Anesthesiology and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier University, School of Medicine, Montpellier, France
- Basic Science Research Unit, INSERM UMR U1298, NeuroSciences Institute, Montpellier, France
| | | | | | - Jean-Christophe Rigal
- Service d'anesthésie et de réanimation chirurgicale, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Patrice Mertl
- Service d'orthopédie et traumatologie, CHU Amiens-Picardie, Amiens, France
| | - Pierre Ghewy
- Pôle d'anesthésie-réanimation, CHU de Lille, Lille, France
| | - Frédéric Farizon
- Department of Orthopedic Surgery, University Hospital Centre of Saint-Etienne, Hôpital Nord, Saint-Étienne, France
| | - Thomas Lanz
- Anesthésie-Réanimation, Clinique de la Sauvegarde, Lyon, France
| | - Axel Buckert
- Anesthésie-Réanimation, Hôpital Privé NATECIA, Avenue Rockefeller, Lyon, France
| | - Samia Belarbia
- Service d'anesthésie et de réanimation chirurgicale, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Noël Trochu
- INSERM, Institut du Thorax, CNRS, University Hospital of Nantes, University of Nantes, Nantes, Franceand
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Peng YF, Zhang QS, Luo WG. The Clinical Usefulness of Mean Corpuscular Hemoglobin Concentration in Patients with Pneumoconiosis. Int J Gen Med 2023; 16:3171-3177. [PMID: 37533840 PMCID: PMC10391047 DOI: 10.2147/ijgm.s417962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
Aim We investigated the clinical usefulness of mean corpuscular hemoglobin concentration (MCHC) in patients with pneumoconiosis. Methods We retrospectively investigated the medical records from 52 patients with pneumoconiosis, and erythrocyte parameters were analyzed in pneumoconiosis patients with different stages. Results Here, we found that the values of MCHC were significantly lower in III stage pneumoconiosis than those with I/II stage (p = 0.024), and there was no significantly difference in MCHC between smoking pneumoconiosis patients and non-smoking pneumoconiosis patients. A negatively correlation between MCHC and disease stage was observed in patients with pneumoconiosis (r = -0.298, p = 0.032). In multiple linear regression analysis, the MCHC was found to be independently associated with advanced pneumoconiosis in patients with pneumoconiosis (p=0.011). The results of logistic regression analysis indicated that decreased MCHC was an independent risk factor of advanced pneumoconiosis in patients with pneumoconiosis (OR: 0.936, CI95%: 0.877-0.999, p = 0.046). Receiver operating characteristic curve analysis showed that the optimal cutoff value of MCHC was 330 g/L to identify advanced pneumoconiosis with the area under the curve of 0.694 (CI95%:0.550-0.839, p = 0.018). Conclusion The decreased MCHC is associated with advanced pneumoconiosis, and MCHC may be used as a monitoring marker for follow-up of pneumoconiosis patients.
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Affiliation(s)
- You-Fan Peng
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, People’s Republic of China
| | - Qing-Song Zhang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, People’s Republic of China
| | - Wei-Gui Luo
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, People’s Republic of China
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10
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Tisserand J, Randrian V, Paccalin M, Saulnier PJ, Arviset M, Fourmy A, Arriudarré V, Jamet A, Moreno Y, Valéro S, Liuu E. Association between Iron Deficiency and Survival in Older Patients with Cancer. Cancers (Basel) 2023; 15:cancers15051533. [PMID: 36900329 PMCID: PMC10000607 DOI: 10.3390/cancers15051533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND iron deficiency (ID) is frequent in older patients. PURPOSE to evaluate the association between ID and survival in patients ≥ 75 years old with confirmed solid tumors. METHODS a retrospective monocentric study including patients between 2009 and 2018. ID, absolute ID (AID) and functional ID (FID) were defined according to the European Society for Medical Oncology (ESMO) criteria. Severe ID was defined by a ferritin level < 30 µg/L. RESULTS in total, 556 patients were included, the mean age was 82 (±4.6) years, 56% were male, the most frequent cancer was colon cancer (19%, n = 104), and metastatic cancers were found in 38% (n = 211). Median follow-up time: 484 [190-1377] days. In anemic patients, ID and FID were independently associated with an increased risk of mortality (respectively, HR 1.51; p = 0.0065 and HR 1.73; p = 0.0007). In non-anemic patients, FID was independently associated with better survival (HR 0.65; p = 0.0495). CONCLUSION in our study, ID was significantly associated with survival, and with better survival for patients without anemia. These results suggest that attention should be paid to the iron status in older patients with tumors and raise questions about the prognostic value of iron supplementation for iron-deficient patients without anemia.
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Affiliation(s)
- Julie Tisserand
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Violaine Randrian
- ProDiCeT, CHU Poitiers, Université de Poitiers, 86000 Poitiers, France
- Gastroenterology and Hepatology Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Marc Paccalin
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Pierre-Jean Saulnier
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Marine Arviset
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Arthur Fourmy
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Victor Arriudarré
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Amélie Jamet
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Yvan Moreno
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Simon Valéro
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Evelyne Liuu
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
- Correspondence:
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11
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Guibergia C, Brazier F, Choukroun G. [Management of iron deficiency in chronic kidney disease: Review and proposed algorithm]. Nephrol Ther 2022; 18:658-665. [PMID: 36435741 DOI: 10.1016/j.nephro.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022]
Abstract
Iron deficiency is very common in chronic kidney disease, even before the dialysis stage. It is an independent factor of morbidity and mortality in patients with non-dialysis chronic kidney disease. During chronic kidney disease, iron deficiency is defined by a transferrin saturation <20% and/or a serum ferritin <100 μg/L. In France, about half of non-dialysis chronic kidney disease patients have absolute iron deficiency (transferrin saturation <20% and serum ferritin <100 μg/L) and/or functional iron deficiency (transferrin saturation <20% and serum ferritin >100 μg/L). Despite this, iron deficiency is usually not investigated. In fact, more than 60% of nephrologists do not assess iron status at least once a year. In addition, iron deficiency is rarely treated: only 12% of patients are prescribed oral or intravenous iron. Early detection and treatment are fundamental and should be systematic. In order to help improve the management of iron deficiency among non-dialysis chronic kidney disease patients, we propose an algorithm that takes into account current recommendations and the most recent data from the literature. Initial blood test requires the measurement of hemoglobin concentration, transferrin saturation and serum ferritin. A transferrin saturation <20% establishes the diagnosis of iron deficiency and the serum ferritin level points towards an absolute or functional deficiency. The combination of both values makes it possible to adapt the treatment, particularly in an inflammatory context where oral iron is not effective.
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Affiliation(s)
- Corinne Guibergia
- Service de néphrologie hémodialyse, clinique Sainte-Marguerite, Hyères, France.
| | - François Brazier
- Service de néphrologie, médecine interne, dialyse, transplantation, CHU d'Amiens-Picardie, unité MP3CV, université de Picardie Jules Verne, Amiens, France
| | - Gabriel Choukroun
- Service de néphrologie, médecine interne, dialyse, transplantation, CHU d'Amiens-Picardie, unité MP3CV, université de Picardie Jules Verne, Amiens, France
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12
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Hof L, Old O, Steinbicker A, Meybohm P, Choorapoikayil S, Zacharowski K. Iron deficiency in cardiac surgical patients. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.4.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Iron is an essential element and involved in a variety of metabolic processes including oxygen transport, cellular energy production, energy metabolism of heart muscles, brain function, cell growth and cell differentiation. Preoperative anaemia is an independent risk factor for poor outcome. Recently, iron deficiency was considered only in the context of anaemia. However, negative consequences of iron deficiency in the absence of anaemia have been described for patients undergoing cardiac surgery. To date, the benefit of intravenous iron supplementation in these patients has been controversially debated. In this review, we discuss the latest progress in studies of intravenous iron supplementation in iron deficient cardiac surgical patients.
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13
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Altieri C, Pisano C, Vincenzo L, Ferrante MS, Pellerito V, Nardi P, Bassano C, Buioni D, Greco E, Ruvolo G, Balistreri CR. Circulating Levels of Ferritin, RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation. Int J Mol Sci 2022; 23:14800. [PMID: 36499124 PMCID: PMC9741292 DOI: 10.3390/ijms232314800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery in conventional extracorporeal circulation (CECC), with an incidence of 15-50%. The POAF pathophysiology is not known, and no blood biomarkers exist. However, an association between increased ferritin levels and increased AF risk, has been demonstrated. Based on such evidence, here, we evaluated the effectiveness of ferritin and other haematological parameters as POAF risk biomarkers in patients subjected to cardiac surgery. We enrolled 105 patients (mean age = 70.1 ± 7.1 years; 70 men and 35 females) with diverse heart pathologies and who were subjected to cardiothoracic surgery. Their blood samples were collected and used to determine hematological parameters. Electrocardiographic and echocardiographic parameters were also evaluated. The data obtained demonstrated significantly higher levels of serum ferritin, red cell distribution width (RDW), and platelets (PLTs) in POAF patients. However, the serum ferritin resulted to be the independent factor associated with the onset POAF risk. Thus, we detected the ferritin cut-off value, which, when ≥148.5 ng/mL, identifies the subjects at the highest POAF risk, and with abnormal ECG atrial parameters, such as PW indices, and altered structural heart disease variables. Serum ferritin, RDW, and PTLs represent predictive biomarkers of POAF after cardiothoracic surgery in CECC; particularly, serum ferritin combined with anormal PW indices and structural heart disease variables can represent an optimal tool for predicting not only POAF, but also the eventual stroke onset.
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Affiliation(s)
- Claudia Altieri
- Department of Cardiac Surgery, Tor Vergata University Rome, 00133 Rome, Italy
| | - Calogera Pisano
- Department of Cardiac Surgery, Tor Vergata University Rome, 00133 Rome, Italy
| | - Labriola Vincenzo
- Department of Cardiac Surgery, Tor Vergata University Rome, 00133 Rome, Italy
| | | | - Valentina Pellerito
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Corso Tukory 211, 90134 Palermo, Italy
| | - Paolo Nardi
- Department of Cardiac Surgery, Tor Vergata University Rome, 00133 Rome, Italy
| | - Carlo Bassano
- Department of Cardiac Surgery, Tor Vergata University Rome, 00133 Rome, Italy
| | - Dario Buioni
- Department of Cardiac Surgery, Tor Vergata University Rome, 00133 Rome, Italy
| | - Ernesto Greco
- Cardiac Surgery Unit, Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University Rome, 00161 Rome, Italy
| | - Giovanni Ruvolo
- Department of Cardiac Surgery, Tor Vergata University Rome, 00133 Rome, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Corso Tukory 211, 90134 Palermo, Italy
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14
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Loveikyte R, Boer M, van der Meulen CN, ter Steege RWF, Tack G, Kuyvenhoven J, Jharap B, Vu MK, Vogelaar L, West RL, van der Marel S, Römkens TEH, Mujagic Z, Hoentjen F, van Bodegraven AA, van Schaik FDM, de Vries AC, Dijkstra G, van der Meulen-de Jong AE. Anemia and Iron Deficiency in Outpatients with Inflammatory Bowel Disease: Ubiquitous Yet Suboptimally Managed. J Clin Med 2022; 11:jcm11226843. [PMID: 36431320 PMCID: PMC9692778 DOI: 10.3390/jcm11226843] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Iron deficiency (ID) and anemia in patients with Inflammatory Bowel Disease (IBD) are associated with a reduced quality of life. We assessed the prevalence of ID and anemia in Dutch outpatients with IBD and compared routine ID(A) management among medical professionals to the European Crohn’s and Colitis Organisation (ECCO) treatment guidelines. Methods: Between January and November 2021, consecutive adult outpatients with IBD were included in this study across 16 Dutch hospitals. Clinical and biochemical data were extracted from medical records. Additionally, medical professionals filled out questionnaires regarding routine ID(A) management. Results: In total, 2197 patients (1271 Crohn’s Disease, 849 Ulcerative Colitis, and 77 IBD-unclassified) were included. Iron parameters were available in 59.3% of cases. The overall prevalence of anemia, ID, and IDA was: 18.0%, 43.4%, and 12.2%, respectively. The prevalence of all three conditions did not differ between IBD subtypes. ID(A) was observed more frequently in patients with biochemically active IBD than in quiescent IBD (ID: 70.8% versus 23.9%; p < 0.001). Contrary to the guidelines, most respondents prescribed standard doses of intravenous or oral iron regardless of biochemical parameters or inflammation. Lastly, 25% of respondents reported not treating non-anemic ID. Conclusions: One in five patients with IBD suffers from anemia that—despite inconsistently measured iron parameters—is primarily caused by ID. Most medical professionals treat IDA with oral iron or standard doses of intravenous iron regardless of biochemical inflammation; however, non-anemic ID is often overlooked. Raising awareness about the management of ID(A) is needed to optimize and personalize routine care.
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Affiliation(s)
- Roberta Loveikyte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Menno Boer
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Catharina N. van der Meulen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Rinze W. F. ter Steege
- Department of Gastroenterology and Hepatology, Martini Hospital, 9728 NT Groningen, The Netherlands
| | - Greetje Tack
- Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - Johan Kuyvenhoven
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis Hospital, 2000 AK Haarlem, The Netherlands
| | - Bindia Jharap
- Department of Gastroenterology and Hepatology, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - My K. Vu
- Department of Gastroenterology and Hepatology, Alrijne Hospital, 2350 CC Leiderdorp, The Netherlands
| | - Lauran Vogelaar
- Department of Gastroenterology and Hepatology, Diakonessenhuis Hospital, 3582 KE Utrecht, The Netherlands
| | - Rachel L. West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland Hospital, 3004 BA Rotterdam, The Netherlands
| | - Sander van der Marel
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands
| | - Tessa E. H. Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 5223 GZ Den Bosch, The Netherlands
| | - Zlatan Mujagic
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, 6525 GA Nijmegen, The Netherlands
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2X8, Canada
| | - Adriaan A. van Bodegraven
- Department of Gastroenterology, Geriatrics, Internal- and Intensive Care Medicine (COMIK), Zuyderland Medical Center, 6130 MB Sittard-Geleen, The Netherlands
| | - Fiona D. M. van Schaik
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Annemarie C. de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Erasmus University Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Andrea E. van der Meulen-de Jong
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-71-5263507
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15
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Wang X, Zhao Y, Wu X, Cui L, Mao S. Editorial: Trace element chemistry and health. Front Nutr 2022; 9:1034577. [PMID: 36386949 PMCID: PMC9644242 DOI: 10.3389/fnut.2022.1034577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Xinyu Wang
- Department of Medicinal Chemistry, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Yahao Zhao
- Department of Medicinal Chemistry, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Xueming Wu
- Zhejiang Huayu Food Co., Ltd., Lishui, China
| | - Leqi Cui
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, United States
- Leqi Cui
| | - Shuai Mao
- Department of Medicinal Chemistry, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Shuai Mao
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16
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Tan N, Cai Y, Liu J, Wang X, Ma L, Ling G, Jiang J, Wang Q, Wang Y. Effects and Safety of Oral Iron for Heart Failure with Iron Deficiency: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. Cardiovasc Ther 2022; 2022:6442122. [PMID: 36186487 PMCID: PMC9509286 DOI: 10.1155/2022/6442122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/03/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Oral iron supplement is commonly prescribed to heart failure patients with iron deficiency. However, the effects of oral iron for heart failure remain controversial. This study included randomized controlled trials (RCTs) for meta-analysis to evaluate the effects of oral iron for heart failure patients. Methods Nine databases (The Cochrane Library, Embase, PubMed, CINAHL, Web of science, CNKI, SinoMed, VIP, and Wanfang) were searched for RCTs of oral iron for heart failure from inception to October 2021. The effects were assessed with a meta-analysis using Revman 5.3 software. The trial sequential analysis was performed by TSA 0.9.5.10 beta software. The risk of bias of trials was evaluated via Risk of Bias tool. The evidence quality was assessed through GRADE tool. Results Four studies including 582 patients with heart failure and iron deficiency were enrolled. The results indicated that oral iron treatment could improve left ventricular ejection fraction (LVEF, MD = 1.52%, 95% CI: 0.69 to 2.36, P = 0.0003) and serum ferritin (MD = 1.64, 95% CI: 0.26 to 3.02, P = 0.02). However, there was no between-group difference in the 6-minute walk distances (6MWT), N terminal pro B type natriuretic peptide (NT-proBNP) or hemoglobin level when compared with control group. Subgroup analyses revealed that the effects of oral iron on 6 MWT and serum ferritin could not be affected by duration and frequency of oral iron uptakes. In trial sequential analysis of LVEF and serum ferritin, the Z-curves crossed the traditional boundary and trail sequential monitoring boundary but did not reach the required information size. Conclusion This analysis showed that oral iron could improve cardiac function measured by LVEF, and iron stores measured serum ferritin, but lack of effect on exercise capacity measured by 6 MWT, and iron stores measured by hemoglobin. Given the overall poor methodological quality and evidence quality, these findings should be treated cautiously.
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Affiliation(s)
- Nannan Tan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of TCM Syndrome and Formula, Beijing, China
- Key Laboratory of Beijing University of Chinese Medicine, Ministry of Education, China
| | - Yiqing Cai
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Junjie Liu
- Department of Cardiology, Nanjing Pukou Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xiaoping Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of TCM Syndrome and Formula, Beijing, China
- Key Laboratory of Beijing University of Chinese Medicine, Ministry of Education, China
| | - Lin Ma
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of TCM Syndrome and Formula, Beijing, China
- Key Laboratory of Beijing University of Chinese Medicine, Ministry of Education, China
| | - Guanjing Ling
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of TCM Syndrome and Formula, Beijing, China
- Key Laboratory of Beijing University of Chinese Medicine, Ministry of Education, China
| | - Jinchi Jiang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of TCM Syndrome and Formula, Beijing, China
- Key Laboratory of Beijing University of Chinese Medicine, Ministry of Education, China
| | - Qiyan Wang
- Beijing Key Laboratory of TCM Syndrome and Formula, Beijing, China
- Key Laboratory of Beijing University of Chinese Medicine, Ministry of Education, China
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of TCM Syndrome and Formula, Beijing, China
- Key Laboratory of Beijing University of Chinese Medicine, Ministry of Education, China
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17
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Kotla NK, Dutta P, Parimi S, Das NK. The Role of Ferritin in Health and Disease: Recent Advances and Understandings. Metabolites 2022; 12:metabo12070609. [PMID: 35888733 PMCID: PMC9320524 DOI: 10.3390/metabo12070609] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Systemic iron homeostasis needs to be tightly controlled, as both deficiency and excess iron cause major global health concerns, such as iron deficiency anemia, hemochromatosis, etc. In mammals, sufficient dietary acquisition is critical for fulfilling the systemic iron requirement. New questions are emerging about whether and how cellular iron transport pathways integrate with the iron storage mechanism. Ferritin is the intracellular iron storage protein that stores surplus iron after all the cellular needs are fulfilled and releases it in the face of an acute demand. Currently, there is a surge in interest in ferritin research after the discovery of novel pathways like ferritinophagy and ferroptosis. This review emphasizes the most recent ferritin-related discoveries and their impact on systemic iron regulation.
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