Transferrin Saturation, Serum Ferritin, and C-Reactive Protein vs. Serum Ferritin for an optimal Iron Deficiency Diagnosis in Candidates for Bariatric Surgery
Introduction Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as...
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| Published in: | Obesity surgery Vol. 34; no. 4; pp. 1174 - 1184 |
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| Abstract | Introduction
Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID.
Materials and Methods
We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30–100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100–300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%).
Results
The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%.
Conclusion
The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity.
Graphical Abstract |
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| AbstractList | Introduction
Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID.
Materials and Methods
We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30–100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100–300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%).
Results
The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%.
Conclusion
The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity.
Graphical Abstract INTRODUCTIONIron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID.MATERIALS AND METHODSWe present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30-100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100-300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%).RESULTSThe prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%.CONCLUSIONThe inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity. Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID. We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30-100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100-300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%). The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%. The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity. |
| Author | Muñoz, M. Patricia Sánchez Blandón, José D. Reyes Ramirez, Zuleyma P. Bello Orozco, César A. Ortiz Rodriguez, Eduardo L. Martínez Aguiñaga, Soledad Aldana Yáñez, Allison R. Esparza |
| Author_xml | – sequence: 1 givenname: M. Patricia Sánchez surname: Muñoz fullname: Muñoz, M. Patricia Sánchez organization: Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara “Dr Juan I. Menchaca” – sequence: 2 givenname: Zuleyma P. Bello surname: Ramirez fullname: Ramirez, Zuleyma P. Bello email: zuleymabello@hotmail.com organization: Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara “Dr Juan I. Menchaca” – sequence: 3 givenname: Eduardo L. Martínez surname: Rodriguez fullname: Rodriguez, Eduardo L. Martínez organization: Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara “Dr Juan I. Menchaca” – sequence: 4 givenname: José D. Reyes surname: Blandón fullname: Blandón, José D. Reyes organization: Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara “Dr Juan I. Menchaca” – sequence: 5 givenname: Soledad Aldana surname: Aguiñaga fullname: Aguiñaga, Soledad Aldana organization: Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara “Dr Juan I. Menchaca” – sequence: 6 givenname: César A. Ortiz surname: Orozco fullname: Orozco, César A. Ortiz organization: General Surgery Department, The Civil Hospital of Guadalajara “Dr Juan I. Menchaca” – sequence: 7 givenname: Allison R. Esparza surname: Yáñez fullname: Yáñez, Allison R. Esparza organization: University Center for Biological and Agricultural Sciences, University of Guadalajara |
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| Keywords | Iron deficiency C-reactive protein Ferritin |
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Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation.... Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity... IntroductionIron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation.... INTRODUCTIONIron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation.... |
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| SubjectTerms | Diagnostic tests Gastrointestinal surgery Iron Medicine Medicine & Public Health Obesity Original Contributions Surgery |
| Title | Transferrin Saturation, Serum Ferritin, and C-Reactive Protein vs. Serum Ferritin for an optimal Iron Deficiency Diagnosis in Candidates for Bariatric Surgery |
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