Iron Status in Patients with SARS-CoV-2 Infection

This study evaluated the iron status and diagnostic usefulness of iron-related parameters in patients with SARS-CoV-2 infection upon admission to the hospital and during hospitalization. The study group included 87 patients with COVID-19 and 45 healthy subjects. Serum iron, ferritin, transferrin, transferrin saturation (TSAT), soluble transferrin receptor (sTfR), and hepcidin concentrations were measured using routine laboratory methods. Serum iron, transferrin concentrations, and TSAT were significantly decreased in COVID-19 on hospital admission, before initiation of treatment, whereas ferritin and hepcidin levels were increased in comparison to the control group (p < 0.001, p < 0.001, p = 0.048, p < 0.001, and p < 0.001, respectively). Serum iron and ferritin levels were significantly higher after hospitalization than those on admission (p < 0.05 for all comparisons). Significant differences were observed only in ferritin and transferrin levels between the groups categorized according to disease severity (p = 0.002 and p < 0.001, respectively); levels were significantly higher in patients with critical disease severity compared to those with moderate disease severity (p = 0.005 and p < 0.001, respectively). Transferrin also showed a negative correlation with disease severity (p = 0.040). Serum ferritin and TSAT levels were significantly higher, whereas transferrin concentration was significantly lower in patients with cytokine storm compared to those without it (p < 0.001, p = 0.011, and p < 0.001, respectively). Ferritin and TSAT also showed a positive correlation, while transferrin revealed a negative correlation with the cytokine storm (p < 0.001, p = 0.011, and p < 0.001, respectively). Additionally, serum ferritin concentrations were significantly decreased, while transferrin levels were increased in survivors compared to non-survivors (p = 0.015 and p = 0.001, respectively). Changes in ferritin, transferrin, TSAT, and hepcidin concentrations were significantly associated with inflammatory markers and hematological parameters. The results of our study indicate that iron homeostasis is disrupted in patients with COVID-19. This dysregulation may contribute to impaired hemoglobin synthesis and could play a role in the development of anemia of inflammation. Furthermore, alterations in iron-related biomarkers were associated with disease severity in patients with SARS-CoV-2 infection. While these findings suggest a potential role for these indices in disease assessment, additional studies incorporating appropriate predictive analyses are required to establish their diagnostic and prognostic value.