OBJECTIVES: Antiviral treatment in chronic hepatitis C (CHC) involves ribavirin, a hemolytic agent. We planned a prospective study to evaluate whether drug-induced iron perturbation is clinically relevant as it relates to therapeutic outcome. METHODS: Iron variables were sequentially assessed in 206 CHC patients undergoing antiviral therapy and were correlated with pretreatment iron status and histology, hemolysis, and therapeutic outcome. RESULTS: At week 1 of therapy, serum iron (SI), transferrin saturation (TS), and serum ferritin (SF) increased markedly in all patients. All iron parameters correlated with hemolysis up to week 4; this correlation was lost for SF at later time points. SF rise during treatment was inversely related to baseline SF and iron deposits in hepatic mesenchymal/Kupffer cells. Both baseline SF and mesenchymal iron significantly correlated with fibrosis at multivariate analysis (P=0.015 and 0.008, respectively). Interestingly, baseline SF, despite good specificity (89%), had low sensitivity in predicting siderosis (25%). During therapy, SI, TS, and hemolysis parameters did not correlate with sustained virological response (SVR), whereas SF rise became an independent predictor of therapeutic response: a 2.5-fold increase of SF at week 12 associated with higher likelihood of SVR (odds ratio 1.91, P=0.032). Accordingly, lack of mesenchymal iron deposits at the baseline biopsy correlated with SVR (odds ratio 3.02, P=0.043). CONCLUSIONS: In CHC, SF is a useful marker for assessing disease duration and progression before starting treatment and for predicting therapeutic response while on therapy. SF rise during antiviral therapy is largely independent of hemolysis and likely indicates activation of macrophages in response to antivirals.

Serum ferritin as a predictor of treatment outcome in patients with chronic hepatitis C / F., Ferrara; Ventura, Paolo; Vegetti, Alberto; M., Guido; G., Abbati; Corradini, Elena; G., Fattovich; C., Ferrari; M., Tagliazucchi; A., Carbonieri; A., Orlandini; S., Fagiuoli; S., Boninsegna; E., Minola; G., Rizzo; F., Belussi; M., Felder; M., Massari; G., Pozzato; S., Bonetto; P., Rovere; C., Sardini; A., Borghi; M. L., Zeneroli; P., Toniutto; E., Rossi; Pietrangelo, Antonello. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - STAMPA. - 104:3(2009), pp. 605-616. [10.1038/ajg.2008.126]

Serum ferritin as a predictor of treatment outcome in patients with chronic hepatitis C

VENTURA, Paolo;VEGETTI, Alberto;CORRADINI, Elena;PIETRANGELO, Antonello
2009

Abstract

OBJECTIVES: Antiviral treatment in chronic hepatitis C (CHC) involves ribavirin, a hemolytic agent. We planned a prospective study to evaluate whether drug-induced iron perturbation is clinically relevant as it relates to therapeutic outcome. METHODS: Iron variables were sequentially assessed in 206 CHC patients undergoing antiviral therapy and were correlated with pretreatment iron status and histology, hemolysis, and therapeutic outcome. RESULTS: At week 1 of therapy, serum iron (SI), transferrin saturation (TS), and serum ferritin (SF) increased markedly in all patients. All iron parameters correlated with hemolysis up to week 4; this correlation was lost for SF at later time points. SF rise during treatment was inversely related to baseline SF and iron deposits in hepatic mesenchymal/Kupffer cells. Both baseline SF and mesenchymal iron significantly correlated with fibrosis at multivariate analysis (P=0.015 and 0.008, respectively). Interestingly, baseline SF, despite good specificity (89%), had low sensitivity in predicting siderosis (25%). During therapy, SI, TS, and hemolysis parameters did not correlate with sustained virological response (SVR), whereas SF rise became an independent predictor of therapeutic response: a 2.5-fold increase of SF at week 12 associated with higher likelihood of SVR (odds ratio 1.91, P=0.032). Accordingly, lack of mesenchymal iron deposits at the baseline biopsy correlated with SVR (odds ratio 3.02, P=0.043). CONCLUSIONS: In CHC, SF is a useful marker for assessing disease duration and progression before starting treatment and for predicting therapeutic response while on therapy. SF rise during antiviral therapy is largely independent of hemolysis and likely indicates activation of macrophages in response to antivirals.
2009
104
3
605
616
Serum ferritin as a predictor of treatment outcome in patients with chronic hepatitis C / F., Ferrara; Ventura, Paolo; Vegetti, Alberto; M., Guido; G., Abbati; Corradini, Elena; G., Fattovich; C., Ferrari; M., Tagliazucchi; A., Carbonieri; A., Orlandini; S., Fagiuoli; S., Boninsegna; E., Minola; G., Rizzo; F., Belussi; M., Felder; M., Massari; G., Pozzato; S., Bonetto; P., Rovere; C., Sardini; A., Borghi; M. L., Zeneroli; P., Toniutto; E., Rossi; Pietrangelo, Antonello. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - STAMPA. - 104:3(2009), pp. 605-616. [10.1038/ajg.2008.126]
F., Ferrara; Ventura, Paolo; Vegetti, Alberto; M., Guido; G., Abbati; Corradini, Elena; G., Fattovich; C., Ferrari; M., Tagliazucchi; A., Carbonieri; ...espandi
File in questo prodotto:
File Dimensione Formato  
Ferrara et al-AJG2009.pdf

Accesso riservato

Tipologia: Versione pubblicata dall'editore
Dimensione 282.17 kB
Formato Adobe PDF
282.17 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/616560
Citazioni
  • ???jsp.display-item.citation.pmc??? 7
  • Scopus 35
  • ???jsp.display-item.citation.isi??? 29
social impact