Prognostic value of various iron deficiency criteria in patients with decompensated heart failure

Kobalava Zh.D.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

Lapshin A.A.: Peoples' Friendship University of Russia (RUDN), Vinogradov City Clinical Hospital, Moscow, Russia

Galochkin S.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Download in PDF

Summary

Aim

To evaluate prognosis of hospitalized patients with decompensated heart failure (HF) and iron deficiency (ID) and the changes in ID occurrence without iron supplementation.

Material and methods

In a prospective study, we enrolled 223 patients with decompensated heart failure (median age 73 [65; 82] years). Serum iron, transferrin, ferritin, transferrin iron saturation (TSAT) and NT-proBNP were determined in all patients. The presence of ID was assessed using two criteria: (1) ferritin <100 ng/ml or 100-299 ng/ml + TSAT <20%; (2) TSAT <20% and serum iron <13 μmol/L. The primary composite endpoint was rehospitalization and death from any cause within 12 months after hospitalization, whereas the secondary endpoints were individual components of the primary endpoint.

Results

According to criteria 1 and 2, ID was detected in 199 (89%) and 156 (70%) patients, respectively. The presence of ID according to criterion 2 was associated with an increased risk of the composite primary endpoint (hazard ratio [HR] 2.38; 95% confidence interval [CI] 1.52-7.49, p=0.003) and hospitalization for any cause (HR 2,40; 95% CI 1.01-5.69, p=0.047). The presence of ID according to criterion 1 did not have a significant effect on the occurrence of endpoints. Decreased TSAT (RR 0.91; 95% CI 0.87-0.96, p<0.001) and elevated ferritin levels (RR 1.01; 95% CI 1.00-1 .01, p<0.001) were associated with a higher risk of death from any cause. The occurrence of ID in patients with decompensated HF decreased from hospitalization to discharge (by 9% according to ID criterion 1 and by 10% according to ID criterion 2) and at 3 months (by 14% and 17%, respectively). Significant predictors of ID resolution without administration of iron supplements have not been established.

Conclusion

Criterion 2 of ID had prognostic significance, in contrast to criterion 1. An unfavorable prognosis was indicated by a decrease in TSAT, and not in the level of ferritin. A decrease in the frequency of ID was found after 3 months in patients on guideline-directed treatment for HF without iron supplementation.

Key words

Heart failure, iron deficiency, transferrin saturation