Hyperferritinemia may indicate progression of liver disease, poor prognosis in MAFLD
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CHARLOTTE, N.C. — Elevated ferritin correlated with an increased prevalence of cirrhosis — but not congestive heart failure — in patients with metabolic dysfunction-associated fatty liver disease, according to a presenter here.
“There is emerging evidence that excess iron levels can increase risk of progression of MAFLD to NASH/cirrhosis and development of cardiac diseases in this patient population. This is significant since we know that cardiac disease is one of the top causes of death in patients with MAFLD,” Deepika Suresh, MD, an internal medicine resident at the University of Michigan, said during a presentation at the ACG Annual Scientific Meeting. “The purpose of our study was to explore the relationship between hyperferritinemia and prevalence of cirrhosis and congestive heart failure in patients with MAFLD after adjustment for other risk factors.”
The cross-sectional analysis included 7,705 adult patients with MAFLD seen at Michigan Medicine between 2010 and 2021, of whom 1,762 (22.9%) had elevated ferritin, dichotomized with a cutoff of 300 µg/L for women and 450 µg/L for men. Researchers performed a multivariate logistic regression analysis, adjusting for age, sex, diabetes, dyslipidemia, hypertension and elevated aspartate aminotransferase levels.
According to the presentation, patients with high vs. low ferritin levels were older (average age, 52.66 vs. 50.51 years) and a greater proportion were men (61.3% vs. 47.9%). Also, a greater proportion of patients with high vs. low ferritin levels had a fibrosis-4 index score greater than 3.25 (29.1% vs. 8.9%), a nonalcoholic fatty liver disease fibrosis score greater than 0.676 (35.3% vs. 22.3%) and an AST level greater than the upper limit of normal (ULN; 79.7% vs. 61.6%).
After adjusting for gender, age, diabetes, hypertension, dyslipidemia and AST levels, elevated ferritin was associated with an increased prevalence of cirrhosis (OR = 1.24; 95% CI, 1.06-1.45). In addition, variables independently associated with increased prevalence of cirrhosis included diabetes (OR = 1.93; 95% CI, 1.66-2.25) and AST levels greater than ULN (OR = 2.87; 95% CI, 2.4-3.43).
In contrast, congestive heart failure was not associated with high ferritin after adjusting for other risk factors (OR = 1.04; 95% CI, 0.84-1.3). This cohort did, however, demonstrate an increased prevalence of congestive heart failure associated with diabetes (OR = 1.58; 95% CI, 1.3-1.92) and hypertension (OR = 3.79; 95% CI, 2.82-5.08).
Suresh acknowledged several study limitations, including being conducted at a single center, causality was not determined from prevalence results and several confounding factors were not measured. The biggest limitation, according to Suresh, was selection bias in only including patients with measured ferritin levels.
“Hyperferritinemia may be a poor prognostic indicator in MAFLD. Patients with MAFLD and elevated ferritin may warrant close surveillance of progression of liver disease,” Suresh said. “Further longitudinal studies are necessary in order to further explore this relationship and possible therapeutic interventions.”
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Suresh D, et al. Elevated ferritin is associated with increased prevalence of cirrhosis but not congestive heart failure among patients with metabolic dysfunction-associated fatty liver disease. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
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