Serum ferritin as a predictor of treatment outcome in patients with chronic hepatitis C

Francesca Ferrara, Paolo Ventura, Alberto Vegetti, Maria Guido, Gianluca Abbati, Elena Corradini, Giovanna Fattovich, Carlo Ferrari, Mara Tagliazucchi, Anna Carbonieri, Alessandra Orlandini, Stefano Fagiuoli, Sara Boninsegna, Eliseo Minola, Giovanna Rizzo, Fabio Belussi, Martina Felder, Marco Massari, Gabriele Pozzato, Stefania BonettoPierangelo Rovere, Carla Sardini, Athos Borghi, Maria Luisa Zeneroli, Pierluigi Toniutto, Elisabetta Rossi, Antonello Pietrangelo

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Antiviral treatment in chronic hepatitis C (CHC) involves ribavirin, a hemolytic agent. We planned a prospective study to evaluate whether drug-induced iron perturbation is clinically relevant as it relates to therapeutic outcome. METHODS: Iron variables were sequentially assessed in 206 CHC patients undergoing antiviral therapy and were correlated with pretreatment iron status and histology, hemolysis, and therapeutic outcome. RESULTS: At week 1 of therapy, serum iron (SI), transferrin saturation (TS), and serum ferritin (SF) increased markedly in all patients. All iron parameters correlated with hemolysis up to week 4; this correlation was lost for SF at later time points. SF rise during treatment was inversely related to baseline SF and iron deposits in hepatic mesenchymal/Kupffer cells. Both baseline SF and mesenchymal iron significantly correlated with fibrosis at multivariate analysis (P=0.015 and 0.008, respectively). Interestingly, baseline SF, despite good specificity (89%), had low sensitivity in predicting siderosis (25%). During therapy, SI, TS, and hemolysis parameters did not correlate with sustained virological response (SVR), whereas SF rise became an independent predictor of therapeutic response: a 2.5-fold increase of SF at week 12 associated with higher likelihood of SVR (odds ratio 1.91, P=0.032). Accordingly, lack of mesenchymal iron deposits at the baseline biopsy correlated with SVR (odds ratio 3.02, P=0.043). CONCLUSIONS: In CHC, SF is a useful marker for assessing disease duration and progression before starting treatment and for predicting therapeutic response while on therapy. SF rise during antiviral therapy is largely independent of hemolysis and likely indicates activation of macrophages in response to antivirals.

Original languageEnglish
Pages (from-to)605-616
Number of pages12
JournalAmerican Journal of Gastroenterology
Issue number3
Publication statusPublished - Mar 2009

ASJC Scopus subject areas

  • Gastroenterology


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