Study of the relationship between iron metabolism disorders and sepsis-associated liver injury: A prospective observational study

doi:10.3748/wjg.v31.i14.104584

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Apr 14, 2025 (publication date) through Apr 21, 2025

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World Journal of Gastroenterology

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1007-9327

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Observational Study

World J Gastroenterol. Apr 14, 2025; 31(14): 104584
Published online Apr 14, 2025. doi: 10.3748/wjg.v31.i14.104584

Table 1 Baseline characteristics of the sepsis group and the sepsis-associated liver injury group, n (%)

Variables	Total (n = 139)	Sepsis (n = 86)	SALI (n = 53)	P value
Age, year, mean ± SD	67.74 ± 12.78	68.03 ± 13.51	67.26 ± 11.62	0.731
BMI, kg/m², mean ± SD	23.36 ± 4.07	23.08 ± 4.24	23.83 ± 3.76	0.292
SOFA score (except liver function), mean ± SD	7.80 ± 3.47	7.42 ± 3.08	8.17 ± 3.81	0.273
APACHE II score, mean ± SD	20.42 ± 7.32	19.81 ± 7.14	21.42 ± 7.58	0.212
ICU stay, days	7.00 (4.00, 13.50)	7.00 (5.00, 16.00)	6.00 (4.00, 10.00)	0.034^a
Hospital stay, days	9.00 (5.00, 21.00)	9.50 (6.00, 25.75)	9.00 (2.00, 14.00)	0.037^a
Gender				0.265
Male	89 (64.03)	52 (60.47)	37 (69.81)
Female	50 (35.97)	34 (39.53)	16 (30.19)
Smoking history				0.279
No	84 (60.43)	55 (63.95)	29 (54.72)
Yes	55 (39.57)	31 (36.05)	24 (45.28)
Drinking history				< 0.001^a
No	94 (67.63)	68 (79.07)	26 (49.06)
Yes	45 (32.37)	18 (20.93)	27 (50.94)
Hypertension				0.921
No	55 (39.86)	34 (39.53)	21 (40.38)
Yes	83 (60.14)	52 (60.47)	31 (59.62)
Diabetes				0.273
No	105 (76.09)	62 (72.94)	43 (81.13)
Yes	33 (23.91)	23 (27.06)	10 (18.87)
Pulmonary infection				0.002^a
No	63 (45.32)	30 (34.88)	33 (62.26)
Yes	76 (54.68)	56 (65.12)	20 (37.74)
Abdominal infection				0.002^a
No	91 (65.94)	65 (75.58)	26 (50.00)
Yes	47 (34.06)	21 (24.42)	26 (50.00)
Urinary tract infection				0.437
No	125 (89.93)	76 (88.37)	49 (92.45)
Yes	14 (10.07)	10 (11.63)	4 (7.55)
Case fatality, 14 days				0.030^a
No	119 (85.61)	78 (90.70)	41 (77.36)
Yes	20 (14.39)	8 (9.30)	12 (22.64)
Case fatality, 28 days				0.277
No	109 (78.42)	70 (81.40)	39 (73.58)
Yes	30 (21.58)	16 (18.60)	14 (26.42)

^aP < 0.05.

SALI: Sepsis-associated liver injury; BMI: Body mass index; SOFA: Sequential Organ Failure Assessment; ICU: Intensive care unit.

Table 2 Comparison of iron metabolism levels between the two groups of patients

Variables	Total (n = 139)	Sepsis (n = 86)	SALI (n = 53)	P value
SI, μmol/L	7.09 (4.08, 12.59)	4.88 (3.50, 8.04)	12.24 (7.83, 19.37)	< 0.001^a
TIBC, μmol/L	29.16 (23.23, 35.36)	25.69 (20.44, 32.80)	33.02 (29.08, 38.58)	< 0.001^a
sTfR, mg/L	2.21 (1.74, 3.04)	2.17 (1.67, 3.03)	2.22 (1.83, 3.10)	0.328
SF, ng/mL	599.00 (286.00, 1445.00)	456.00 (277.25, 985.75)	866.00 (479.00, 6387.00)	0.001^a
TRF, mg/L	20.96 (17.23, 25.21)	18.79 (16.23, 24.45)	22.39 (18.92, 27.01)	0.005^a
TSAT, %	0.21 (0.15, 0.35)	0.18 (0.13, 0.26)	0.31 (0.17, 0.67)	< 0.001^a

^aP < 0.05.

SALI: Sepsis-associated liver injury; SI: Serum iron; TIBC: Total iron-binding capacity; sTfR: Soluble transferrin receptor; SF: Serum ferritin; TRF: Transferrin; TSAT: Transferrin saturation.

Table 3 Univariate logistic regression analysis of risk factors for sepsis-associated liver injury among patients with sepsis

Variables	OR	P value	95%CI
Age, year	1.00	0.729	0.97-1.02
BMI, kg/m²	1.05	0.292	0.96-1.15
PT, second	1.00	0.942	0.95-1.05
APTT, second	1.00	0.982	0.97-1.03
INR	0.92	0.565	0.68-1.24
PLT, 10⁹/L	0.99	0.028^a	0.99-0.99
ALB, g/L	1.12	0.002^a	1.04-1.21
Lac, mmol/L	1.47	< 0.001^a	1.19-1.80
IL-6, pg/mL	1.00	0.765	1.00-1.00
WBC, 10⁹/L	1.01	0.678	0.97-1.04
NE, 10⁹/L	1.00	0.910	0.97-1.03
SI, μmol/L	1.21	< 0.001^a	1.12-1.32
TIBC, μmol/L	1.12	< 0.001^a	1.06-1.17
sTfR, mg/L	1.17	0.140	0.95-1.45
SF, ng/mL	1.01	0.002^a	1.01-1.01
TSAT, %	29.33	< 0.001^a	5.30-162.35
Gender
Male	1.00		Reference
Female	0.66	0.266	0.32-1.37
Smoking history
No	1.00		Reference
Yes	1.47	0.280	0.73-2.95
Drinking history
No	1.00		Reference
Yes	3.92	< 0.001^a	1.86-8.29
Hypertension
No	1.00		Reference
Yes	0.97	0.921	0.48-1.95
Diabetes
No	1.00		Reference
Yes	0.63	0.275	0.27-1.45
Abdominal infection
No	1.00		Reference
Yes	3.10	0.003^a	1.49-6.44

^aP < 0.05.

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio; PLT: Platelet; ALB: Albumin; IL-6: Interleukin-6; WBC: White blood cell; NE: Neutrophil; SI: Serum iron; TIBC: Total iron-binding capacity; sTfR: Soluble transferrin receptor; SF: Serum ferritin; TSAT: Transferrin saturation.

Table 4 Multivariate logistic regression analysis of risk factors for sepsis-associated liver injury among patients with sepsis

Variables	OR	P value	95%CI
PLT, 10⁹/L	0.99	0.048^a	0.99-0.99
Lac, mmol/L	1.45	0.011^a	1.09-1.93
SI, μmol/L	1.24	< 0.001^a	1.11-1.40
TIBC, μmol/L	1.13	< 0.001^a	1.05-1.21
Drinking history
No	1.00		Reference
Yes	5.22	0.007^a	1.58-17.25
Abdominal infection
No	1.00		Reference
Yes	6.61	0.002^a	2.01-21.72

^aP < 0.05.

OR: Odds ratio; CI: Confidence interval; PLT: Platelet; SI: Serum iron; TIBC: Total iron-binding capacity.

Table 5 Receiver operating characteristic curve analysis of the predictive value of serum iron and total iron-binding capacity for sepsis-associated liver injury

Variables	AUC	Cut-off value	Sensitivity	Specificity	P value	95%CI
SI, μmol/L	0.816	7.745	0.744	0.755	< 0.001^a	0.745-0.887
TIBC, μmol/L	0.757	26.3	0.570	0.906	< 0.001^a	0.677-0.838
SI combined with TIBC	0.865	-	0.826	0.792	< 0.001^a	0.806-0.923

^aP < 0.05.

AUC: Area under the curve; CI: Confidence interval; SI: Serum iron; TIBC: Total iron-binding capacity.

Citation: Wang TW, Zhou LL, Yuan J, Zhou WX, Wang HR, Yu TT, Zhai JC, Tang CB, Jiang W, Yu JQ, Zheng RQ, Yu HL, Shao J. Study of the relationship between iron metabolism disorders and sepsis-associated liver injury: A prospective observational study. World J Gastroenterol 2025; 31(14): 104584
URL: https://www.wjgnet.com/1007-9327/full/v31/i14/104584.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i14.104584