Abstract 4308: Serum ferritin as a predictive marker for increase in infection and increased mortality in patients with myelodysplastic syndrome
Authors: Konde Anish , Puppala Mamta , Srivastava Pallavi , Wong Stephen T. , Baker Kelty , Rice Lawrence , Iyer Swaminathan Padmanabhan 
Published: August 2015

Background: Myelodysplastic Syndrome (MDS) is a disorder of the bone marrow wherein hematopoietic cells fail to develop and differentiate into their mature forms. High iron stores in the body are known to have a detrimental effect on the overall outcome for the patient, however its exact role in the disease spectrum is currently unknown. We sought out to elucidate the role of Serum Ferritin against two end points - infection and death.

Methods: The patient data was queried from METEOR (Methodist Environment for Translational Enhancement and Outcomes Research), a clinical data warehouse and analytics environment. We obtained baseline demographics, laboratory data, diagnostic workup, treatment plan, infection incidences, ferritin levels and dead/alive status.

Results: We reviewed the records of 2249 patients who were treated with a diagnosis of MDS from January 2006 - June 2014. We matched patients with infection during hospital stay due to any cause (sepsis, febrile neutropenia, colitis, pneumonia, URTI, etc) against their maximum ferritin level. The mean Ferritin in those without infection was 809.82 (95% CI: 575.17 - 1044.48) while the mean Ferritin in those with infection was 2360.09 (95% CI: 1094.69 - 4167.12). We then performed the non-parametric, Wilcoxon-Rank sum (Mann-Whitney U) test between the two variables and concluded that there was a statistically significant relationship between Serum Ferritin and Infection rates (p &lt;0.001). A student t-test with unequal variances was performed which, confirmed the statistical significance (p 0.021).

We matched patients who passed away during hospital stay against their maximum ferritin level. The mean Ferritin in those survived was 872.32 (95% CI: 592.96 - 1151.68) while the mean Ferritin in those died was 2941.78 (95% CI: 1255.05 - 4628.50). We then performed the non-parametric, Wilcoxon-Rank sum (Mann-Whitney U) test between the two variables and concluded that there was a statistically significant relationship between Serum Ferritin and death rates (p &lt;0.001). A student t-test with unequal variances was performed which, confirmed the statistical significance (p 0.018).Lastly, we also performed the non-parametric Kruskal-Wallis test to assess for the significance levels across all the three groups - Ferritin, infection and death. This test confirmed the significance with a p value of 0.0001 for each of the outcomes.

Conclusion: Our data review reveals that increased ferritin is directly related to increased mortality and morbidity. One explanation of this finding could lie in the potential role of Iron as an oxidative agent, which increases free radical damage, impair oxidative phosphorylation and promote mitochondrial dysfunction resulting in cellular death. We conclude that increased ferritin represents a serious threat to the health of the patient and recommend that iron chelation therapy be instituted accordingly.

Note: This abstract was not presented at the meeting.

Citation Format: Anish Konde, Mamta Puppala, Pallavi Srivastava, Stephen T. Wong, Kelty Baker, Lawrence Rice, Swaminathan Padmanabhan Iyer. Serum ferritin as a predictive marker for increase in infection and increased mortality in patients with myelodysplastic syndrome. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4308. doi:10.1158/1538-7445.AM2015-4308