This letter offered commentary on the recently published article by Wang et al that investigated the relationship between iron metabolism disorders and sepsis-associated liver injury(SALI).The original study identifie...This letter offered commentary on the recently published article by Wang et al that investigated the relationship between iron metabolism disorders and sepsis-associated liver injury(SALI).The original study identified serum iron and total iron-binding capacity as potential predictive markers of SALI,contributing important insights to critical care hepatology.In this correspondence several methodological considerations that may influence the interpretation and general-izability of the findings were discussed.These include the limitations of a single-center design,the lack of serial biomarker measurements,the omission of hepcidin(a central iron regulatory hormone)as a measured variable,and the exclusive reliance on biochemical criteria for diagnosing liver injury.The potential value of incorporating imaging modalities and additional iron-related markers such as ferritin and transferrin saturation were also highlighted.The aim was to reinforce the importance of a comprehensive approach to iron metabolism in sepsis and to suggest future directions for clinical research that may enhance the diagnostic and prognostic utility of iron-related biomarkers in SALI.展开更多
AIM： To re-evaluate the diagnostic criteria of insulin resistance hepatic iron overload based on clinical, biochemical and histopathological findings. METHODS： We studied 81 patients with hepatic iron overload not e...AIM： To re-evaluate the diagnostic criteria of insulin resistance hepatic iron overload based on clinical, biochemical and histopathological findings. METHODS： We studied 81 patients with hepatic iron overload not explained by known genetic and acquired causes. The metabolic syndrome （MS） was defined according to ATPⅢ criteria. Iron overload was assessed by liver biopsy. Liver histology was evaluated by Ishak＇s score and iron accumulation by Deugnier＇s score; steatosis was diagnosed when present in ≥ 5% of hepatooltes. RESULTS： According to transferrin saturation levels, we observed significant differences in the amount of hepatic iron overload and iron distribution, as well as the number of metabolic abnormalities. Using Receiving Operating Curve analysis, we found that the presence of two components of the MS differentiated two groups with a statistically significant different hepatic iron overload （P 〈 0.0001）. Patients with ≥2 metabolic alterations and steatosis had lower amount of hepatic iron, lower transferrin saturation and higher sinusoidal iron than patients with 〈 2 MS components and absence of steatosis. CONCLUSION： In our patients, the presence of ≥ 2 alterations of the MS and hepatic steatosis was associated with a moderate form of iron overload with a prevalent sinusoidal distribution and a normal transferrin saturation, suggesting the existence of a peculiar pathogenetic mechanism of iron accumulation. These patients may have the typical dysmetabolic iron overload syndrome. By contrast, patients with transferrin saturation ≥ 60% had more severe iron overload, few or no metabolic abnormalities and a hemochromatosis-like pattern of iron overload.展开更多
文摘This letter offered commentary on the recently published article by Wang et al that investigated the relationship between iron metabolism disorders and sepsis-associated liver injury(SALI).The original study identified serum iron and total iron-binding capacity as potential predictive markers of SALI,contributing important insights to critical care hepatology.In this correspondence several methodological considerations that may influence the interpretation and general-izability of the findings were discussed.These include the limitations of a single-center design,the lack of serial biomarker measurements,the omission of hepcidin(a central iron regulatory hormone)as a measured variable,and the exclusive reliance on biochemical criteria for diagnosing liver injury.The potential value of incorporating imaging modalities and additional iron-related markers such as ferritin and transferrin saturation were also highlighted.The aim was to reinforce the importance of a comprehensive approach to iron metabolism in sepsis and to suggest future directions for clinical research that may enhance the diagnostic and prognostic utility of iron-related biomarkers in SALI.
基金Grant from the Association for the Study of Hemochromatosis and Iron Overload Disorders-ONLUS (P.T.), Monza
文摘AIM： To re-evaluate the diagnostic criteria of insulin resistance hepatic iron overload based on clinical, biochemical and histopathological findings. METHODS： We studied 81 patients with hepatic iron overload not explained by known genetic and acquired causes. The metabolic syndrome （MS） was defined according to ATPⅢ criteria. Iron overload was assessed by liver biopsy. Liver histology was evaluated by Ishak＇s score and iron accumulation by Deugnier＇s score; steatosis was diagnosed when present in ≥ 5% of hepatooltes. RESULTS： According to transferrin saturation levels, we observed significant differences in the amount of hepatic iron overload and iron distribution, as well as the number of metabolic abnormalities. Using Receiving Operating Curve analysis, we found that the presence of two components of the MS differentiated two groups with a statistically significant different hepatic iron overload （P 〈 0.0001）. Patients with ≥2 metabolic alterations and steatosis had lower amount of hepatic iron, lower transferrin saturation and higher sinusoidal iron than patients with 〈 2 MS components and absence of steatosis. CONCLUSION： In our patients, the presence of ≥ 2 alterations of the MS and hepatic steatosis was associated with a moderate form of iron overload with a prevalent sinusoidal distribution and a normal transferrin saturation, suggesting the existence of a peculiar pathogenetic mechanism of iron accumulation. These patients may have the typical dysmetabolic iron overload syndrome. By contrast, patients with transferrin saturation ≥ 60% had more severe iron overload, few or no metabolic abnormalities and a hemochromatosis-like pattern of iron overload.
