France Debaugnies, from the team of Dr pharm, Dr sc Patricia Borde, department of medical biology, has just published her collaborative work with Prof Francis Corazza from Université Libre de Bruxelles, in the Journal of Clinical Immunology (doi.org/10.1007/s10875-020-00950-z). She shows that a routine clinical chemistry parameter, ferritin, measured in the serum of patients, is the most discriminating parameter for the early diagnosis of “secondary hemophagocytic lymphohistiocytosis” (HLH). This is a disease, characterized by hyper-inflammation, with symptoms, very similar to those of sepsis.

Severe COVID-19 is also a cytokine storm syndrome, and secondary HLH is often observed in severe COVID-19. Interestingly, two large meta-analyses on tens of thousands of COVID-19 patients (PE Tanieri et al. Env J Epidemiol 2020, and L Cheng et al. J Clin Lab Anal 2020) have both identified high levels of circulating ferritin as the best predictor of worse COVID-19 outcomes. The explanation lies in the link between hypoxia, inflammation, and changes in iron metabolism, with blockage of iron absorption.

The research results by France Debaugnies and their agreement with the above, independent, meta-analyses show that observations made in one clinical domain may be applicable to other domains, and that sometimes, simple clinical laboratory parameters are sufficient to predict complex clinical deteriorations and guide better therapeutic strategies.

It would now be interesting to see if high ferritin concentration is not only retrospectively associated with severe COVID-19, as has been shown in the meta-analyses, but can also be used as an early COVID-19 prognostic test, just as it can be used for secondary HLH.

Link to the publication: https://pubmed.ncbi.nlm.nih.gov/33417087/