CONSENSUS CRITERIA FOR METABOLIC HYPERFERRITINEMIA DIAGNOSIS AND GRADE IN A LARGE COHORT WITH MRI

Background:

Recent consensus for Metabolic hyperferritinemia (MHF) has defined diagnosis criteria and grading with cutoff value for ferritin and hepatic iron concentration (HIC). Our aim was to assess their relevance in a large cohort of patients.

 

Method:

Patients with increased ferritin with available HIC as determined by liver MRI, and fulfilling criteria for MHF according to the recent consensus were included. Multivariate regression analysis was used to identify determinant of HIC and ferritin. ROC curves were used to assess the cut-off suggested.

 

Results:

534 patients (age:58.6±10.6; 79.8% male, BMI 29.5±4.6) were included. Mean ferritin was 866±655µg/L, and HIC was 93±65µmol/g. Strong correlation between ferritin and HIC was observed (rho=0.70). Multivariate analysis revealed significant associations of ferritin with HIC, ASAT, transferrin saturation (Tsat), triglycerides, and smoking. HIC was associated with ferritin, Tsat, BMI, smoking, ASAT, hemoglobin, age, and alcohol consumption.

Grading according to ferritin was 25.3% grade 1, 42.5% grade 2, and 30.9% grade 3. According to HIC grading were 22.3%, 28.3% and 49.4% respectively.

The AUC for ferritin diagnosing HIC≥74µmol/g was 0.83, with a 1000µg/L showing 51% sensitivity, 90% specificity. Patients with Grade 3 MHF according to HIC, were older with lower BMI, higher Tsat, lower ASAT, lower ALT, and lower GGT. Fib4 test results were comparable between MHF grade determined by HIC or ferritin.

 

Conclusion: 

The proposed ferritin and HIC cutoffs effectively stratify MHF severity. However, in our population ferritin tends to underestimate HIC thus emphasizing the importance of integrating both serum ferritin and HIC for comprehensive MHF assessment.