Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit: A nested cohort study

Edward Litton, Stuart Baker, Wendy Erber, Shannon Farmer, Janet Ferrier, Craig J. French, Joel Gummer, David Hawkins, Alisa Higgins, Axel Hofmann, Bart De Keulenaer, Julie McMorrow, John K. Olynyk, Toby Richards, Simon Towler, Robert Trengove, Steve Webb, on behalf of the IRONMAN Study investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Both anaemia and red blood cell (RBC) transfusion are common and associated with adverse outcomes in patients admitted to the intensive care unit (ICU). The aim of this study was to determine whether serum hepcidin concentration, measured early after ICU admission in patients with anaemia, could identify a group in whom intravenous (IV) iron therapy decreased the subsequent RBC transfusion requirement. Methods: We conducted a prospective observational study nested within a multicenter randomized controlled trial (RCT) of IV iron versus placebo. The study was conducted in the ICUs of four tertiary hospitals in Perth, Western Australia. Critically ill patients with haemoglobin (Hb) of <100g/L and within 48h of admission to the ICU were eligible for participation after enrolment in the IRONMAN RCT. The response to IV iron therapy compared with placebo was assessed according to tertile of hepcidin concentration. Results: Hepcidin concentration was measured within 48h of ICU admission in 133 patients. For patients in the lower two tertiles of hepcidin concentration (<53.0μg), IV iron therapy compared with placebo was associated with a significant decrease in RBC transfusion requirement [risk ratio 0.48 (95% CI 0.26-0.85), p=0.013]. Conclusions: In critically ill patients with anaemia admitted to an ICU, baseline hepcidin concentration predicts RBC transfusion requirement and is able to identify a group of patients in whom IV iron compared with placebo is associated with a significant decrease in RBC transfusion requirement.

Original languageEnglish
Article number60
Number of pages7
JournalJournal of Intensive Care
Volume6
Issue number1
DOIs
Publication statusPublished - 10 Sep 2018

Keywords

  • Anaemia
  • Critical care
  • Hepcidin
  • Intravenous iron
  • Red blood cell transfusion

Cite this

Litton, E., Baker, S., Erber, W., Farmer, S., Ferrier, J., French, C. J., ... on behalf of the IRONMAN Study investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group (2018). Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit: A nested cohort study. Journal of Intensive Care, 6(1), [60]. https://doi.org/10.1186/s40560-018-0328-2
Litton, Edward ; Baker, Stuart ; Erber, Wendy ; Farmer, Shannon ; Ferrier, Janet ; French, Craig J. ; Gummer, Joel ; Hawkins, David ; Higgins, Alisa ; Hofmann, Axel ; De Keulenaer, Bart ; McMorrow, Julie ; Olynyk, John K. ; Richards, Toby ; Towler, Simon ; Trengove, Robert ; Webb, Steve ; on behalf of the IRONMAN Study investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. / Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit : A nested cohort study. In: Journal of Intensive Care. 2018 ; Vol. 6, No. 1.
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title = "Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit: A nested cohort study",
abstract = "Background: Both anaemia and red blood cell (RBC) transfusion are common and associated with adverse outcomes in patients admitted to the intensive care unit (ICU). The aim of this study was to determine whether serum hepcidin concentration, measured early after ICU admission in patients with anaemia, could identify a group in whom intravenous (IV) iron therapy decreased the subsequent RBC transfusion requirement. Methods: We conducted a prospective observational study nested within a multicenter randomized controlled trial (RCT) of IV iron versus placebo. The study was conducted in the ICUs of four tertiary hospitals in Perth, Western Australia. Critically ill patients with haemoglobin (Hb) of <100g/L and within 48h of admission to the ICU were eligible for participation after enrolment in the IRONMAN RCT. The response to IV iron therapy compared with placebo was assessed according to tertile of hepcidin concentration. Results: Hepcidin concentration was measured within 48h of ICU admission in 133 patients. For patients in the lower two tertiles of hepcidin concentration (<53.0μg), IV iron therapy compared with placebo was associated with a significant decrease in RBC transfusion requirement [risk ratio 0.48 (95{\%} CI 0.26-0.85), p=0.013]. Conclusions: In critically ill patients with anaemia admitted to an ICU, baseline hepcidin concentration predicts RBC transfusion requirement and is able to identify a group of patients in whom IV iron compared with placebo is associated with a significant decrease in RBC transfusion requirement.",
keywords = "Anaemia, Critical care, Hepcidin, Intravenous iron, Red blood cell transfusion",
author = "Edward Litton and Stuart Baker and Wendy Erber and Shannon Farmer and Janet Ferrier and French, {Craig J.} and Joel Gummer and David Hawkins and Alisa Higgins and Axel Hofmann and {De Keulenaer}, Bart and Julie McMorrow and Olynyk, {John K.} and Toby Richards and Simon Towler and Robert Trengove and Steve Webb and {on behalf of the IRONMAN Study investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group}",
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month = "9",
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Litton, E, Baker, S, Erber, W, Farmer, S, Ferrier, J, French, CJ, Gummer, J, Hawkins, D, Higgins, A, Hofmann, A, De Keulenaer, B, McMorrow, J, Olynyk, JK, Richards, T, Towler, S, Trengove, R, Webb, S & on behalf of the IRONMAN Study investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group 2018, 'Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit: A nested cohort study' Journal of Intensive Care, vol. 6, no. 1, 60. https://doi.org/10.1186/s40560-018-0328-2

Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit : A nested cohort study. / Litton, Edward; Baker, Stuart; Erber, Wendy; Farmer, Shannon; Ferrier, Janet; French, Craig J.; Gummer, Joel; Hawkins, David; Higgins, Alisa; Hofmann, Axel; De Keulenaer, Bart; McMorrow, Julie; Olynyk, John K.; Richards, Toby; Towler, Simon; Trengove, Robert; Webb, Steve; on behalf of the IRONMAN Study investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group.

In: Journal of Intensive Care, Vol. 6, No. 1, 60, 10.09.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit

T2 - A nested cohort study

AU - Litton, Edward

AU - Baker, Stuart

AU - Erber, Wendy

AU - Farmer, Shannon

AU - Ferrier, Janet

AU - French, Craig J.

AU - Gummer, Joel

AU - Hawkins, David

AU - Higgins, Alisa

AU - Hofmann, Axel

AU - De Keulenaer, Bart

AU - McMorrow, Julie

AU - Olynyk, John K.

AU - Richards, Toby

AU - Towler, Simon

AU - Trengove, Robert

AU - Webb, Steve

AU - on behalf of the IRONMAN Study investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group

PY - 2018/9/10

Y1 - 2018/9/10

N2 - Background: Both anaemia and red blood cell (RBC) transfusion are common and associated with adverse outcomes in patients admitted to the intensive care unit (ICU). The aim of this study was to determine whether serum hepcidin concentration, measured early after ICU admission in patients with anaemia, could identify a group in whom intravenous (IV) iron therapy decreased the subsequent RBC transfusion requirement. Methods: We conducted a prospective observational study nested within a multicenter randomized controlled trial (RCT) of IV iron versus placebo. The study was conducted in the ICUs of four tertiary hospitals in Perth, Western Australia. Critically ill patients with haemoglobin (Hb) of <100g/L and within 48h of admission to the ICU were eligible for participation after enrolment in the IRONMAN RCT. The response to IV iron therapy compared with placebo was assessed according to tertile of hepcidin concentration. Results: Hepcidin concentration was measured within 48h of ICU admission in 133 patients. For patients in the lower two tertiles of hepcidin concentration (<53.0μg), IV iron therapy compared with placebo was associated with a significant decrease in RBC transfusion requirement [risk ratio 0.48 (95% CI 0.26-0.85), p=0.013]. Conclusions: In critically ill patients with anaemia admitted to an ICU, baseline hepcidin concentration predicts RBC transfusion requirement and is able to identify a group of patients in whom IV iron compared with placebo is associated with a significant decrease in RBC transfusion requirement.

AB - Background: Both anaemia and red blood cell (RBC) transfusion are common and associated with adverse outcomes in patients admitted to the intensive care unit (ICU). The aim of this study was to determine whether serum hepcidin concentration, measured early after ICU admission in patients with anaemia, could identify a group in whom intravenous (IV) iron therapy decreased the subsequent RBC transfusion requirement. Methods: We conducted a prospective observational study nested within a multicenter randomized controlled trial (RCT) of IV iron versus placebo. The study was conducted in the ICUs of four tertiary hospitals in Perth, Western Australia. Critically ill patients with haemoglobin (Hb) of <100g/L and within 48h of admission to the ICU were eligible for participation after enrolment in the IRONMAN RCT. The response to IV iron therapy compared with placebo was assessed according to tertile of hepcidin concentration. Results: Hepcidin concentration was measured within 48h of ICU admission in 133 patients. For patients in the lower two tertiles of hepcidin concentration (<53.0μg), IV iron therapy compared with placebo was associated with a significant decrease in RBC transfusion requirement [risk ratio 0.48 (95% CI 0.26-0.85), p=0.013]. Conclusions: In critically ill patients with anaemia admitted to an ICU, baseline hepcidin concentration predicts RBC transfusion requirement and is able to identify a group of patients in whom IV iron compared with placebo is associated with a significant decrease in RBC transfusion requirement.

KW - Anaemia

KW - Critical care

KW - Hepcidin

KW - Intravenous iron

KW - Red blood cell transfusion

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U2 - 10.1186/s40560-018-0328-2

DO - 10.1186/s40560-018-0328-2

M3 - Article

VL - 6

JO - Journal of Intensive Care

JF - Journal of Intensive Care

SN - 2052-0492

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