Iron deficiency and short-term adverse events in patients with decompensated heart failure

Abstract

For patients with heart failure (HF), iron deficiency (ID) is a common therapeutic target. However, little is known about the utility of transferrin saturation (TSAT) or serum ferritin for risk stratification in decompensated HF (DHF) or the European Society of Cardiology s (ESC) current definition of ID (ferritin\u2009<\u2009100 μg/L or TSAT\u2009<\u200920% if ferritin is 100–299 μg/L). We evaluated the association between these potential markers of ID and the risk of 30-day readmission for HF or death in patients with DHF. We retrospectively included 1701 patients from a multicenter registry of DHF. Serum ferritin and TSAT were evaluated 24–72 h after hospital admission, and multivariable Cox regression was used to assess their association with the composite endpoint. Participants median (quartiles) age was 76 (68–82) years, 43.8% were women, and 51.7% had a left ventricular ejection fraction\u2009>\u200950%. Medians for NT-proBNP, TSAT, and ferritin were 4067 pg/mL (1900–8764), 14.1% (9.0–20.3), and 103 ug/L (54–202), respectively. According to the current ESC definition, 1,246 (73.3%) patients had ID. By day 30, there were 177 (10.4%) events (95 deaths and 85 HF readmission). After multivariable adjustment, lower TSAT was associated with outcome (p\u2009=\u20090.009) but serum ferritin was not (HR 1.00; 95% confidence interval 0.99–1.00, p\u2009=\u20090.347). Lower TSAT, but not ferritin, was associated with a higher risk of short-term events in patients with DHF. Further research is needed to confirm these findings and the utility of serum ferritin as a marker of ID in DHF.