Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Study of the relationship between iron metabolism disorders and sepsis-associated liver injury: A prospective observational study
Tian-Wei Wang, Lu-Lu Zhou, Jing Yuan, Wen-Xin Zhou, Hao-Ran Wang, Ting-Ting Yu, Ji-Chao Zhai, Cheng-Bin Tang, Wei Jiang, Jiang-Quan Yu, Rui-Qiang Zheng, Hai-Long Yu, Jun Shao
Tian-Wei Wang, Lu-Lu Zhou, Hao-Ran Wang, Ting-Ting Yu, Ji-Chao Zhai, Wei Jiang, Jiang-Quan Yu, Rui-Qiang Zheng, Department of Intensive Care Unit, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, Jiangsu Province, China
Jing Yuan, Department of Functional Examination, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, Jiangsu Province, China
Wen-Xin Zhou, Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
Cheng-Bin Tang, Jun Shao, Department of Center for Cardiac Macrovascular Disease, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, Jiangsu Province, China
Hai-Long Yu, Department of Neuro Intensive Care Unit, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, Jiangsu Province, China
Hai-Long Yu, Department of Neurology, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, Jiangsu Province, China
Co-first authors: Tian-Wei Wang and Lu-Lu Zhou.
Co-corresponding authors: Hai-Long Yu and Jun Shao.
Author contributions: Yu HL and Shao J contributed equally to this study as co-corresponding authors; Yu HL and Shao J conceived and planned this study; Wang TW and Zhou LL contributed equally to this study as co-first authors; Wang TW and Zhou LL performed the vast majority of the data acquisition and analysis for this experiment; Yuan J, Zhou WX, Wang HR, Yu TT, Zhai JC, and Jiang W performed the remaining data collection and analysis; Wang TW wrote the first draft of the manuscript; Tang CB, Yu JQ, and Zheng RQ were responsible for the execution and supervision of the entire project.
Supported by the National Science Foundation of Jiangsu Province, No. BK20221280; the National Natural Science Foundation of China, No. 82371336; the Chinese Postdoctoral Science Foundation, No. 2022M711426; the Special Fund for Social Key Research and Development Plan of Yangzhou City, No. YZ2022097; Yangzhou Municipal Science and Technology Bureau, No. YZ2024091 and No. YZ2022098.
Institutional review board statement: The medical research ethics committee of the Northern Jiangsu People’s Hospital provided approval for this study (ethics number: 2023ky297).
Informed consent statement: All patients were informed about the process and purpose of this study, voluntarily participated, and signed an informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jun Shao, Associate Chief Physician, Department of Center for Cardiac Macrovascular Disease, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, No. 98 Nantong Road West, Guangling District, Yangzhou 225001, Jiangsu Province, China.
sjun1982@163.com
Received: December 25, 2024
Revised: February 17, 2025
Accepted: March 25, 2025
Published online: April 14, 2025
Processing time: 107 Days and 10.4 Hours
BACKGROUND
Sepsis-associated liver injury (SALI) refers to secondary liver function impairment caused by sepsis, patients with SALI often have worse clinical outcomes. The early identification and assessment of the occurrence and progression of SALI are pressing issues that urgently need to be resolved.
AIM
To investigate the relationship between iron metabolism and SALI.
METHODS
In this prospective study, 139 patients were recruited, with 53 assigned to the SALI group. The relationships between SALI and various iron metabolism-related biomarkers were examined. These biomarkers included serum iron (SI), total iron-binding capacity (TIBC), serum ferritin, transferrin, and transferrin saturation. To identify independent risk factors for SALI, both univariate and multivariate logistic regression analyses were performed. Additionally, receiver operating characteristic curve analysis was utilized to assess the predictive value of these biomarkers for the occurrence of SALI.
RESULTS
There were no statistically significant differences in age, sex, body mass index, Sequential Organ Failure Assessment scores (excluding liver function), or APACHE II scores between the two groups of patients. Compared with the sepsis group, the SALI group presented significantly higher SI (P < 0.001), TIBC (P < 0.001), serum ferritin (P = 0.001), transferrin (P = 0.005), and transferrin saturation levels (P < 0.001). Multivariate logistic regression analysis revealed that SI (odds ratio = 1.24, 95% confidence interval: 1.11-1.40, P < 0.001) and TIBC levels (odds ratio = 1.13, 95% confidence interval: 1.05-1.21, P < 0.001) were independent predictors of SALI. Receiver operating characteristic curve analysis revealed that SI and TIBC had areas under the curve of 0.816 and 0.757, respectively, indicating moderate predictive accuracy for SALI.
CONCLUSION
Iron metabolism disorders are closely associated with the development of SALI, and SI and TIBC may serve as potential predictive biomarkers. The combined use of SI and TIBC has superior diagnostic efficacy for SALI. These findings provide valuable insights for the early identification and management of SALI among patients with sepsis.
Core Tip: Sepsis-associated liver injury (SALI) refers to secondary liver function impairment caused by sepsis, the SALI patients often have worse clinical outcomes. Recent evidence has suggested that iron metabolism plays a significant role in the adverse processes of sepsis and sepsis-induced organ damage. Our research indicates that iron metabolism disorders are closely related to the occurrence and development of SALI and that serum iron and total iron-binding capacity can serve as potential predictive indicators for SALI. These findings provide valuable information for further exploration of the mechanisms underlying the occurrence of SALI and the development of new treatment strategies.
