Association Between Ferritin Levels and Sepsis in Patients with COVID-19 at Dr. M. Djamil Hospital

Diana Nur Asrini, Oea Khairsyaf, Afriani Afriani


Background: Ferritin is an important mediator of immunomodulatory dysregulation and pro-inflammatory effects, which contribute to cytokine storms that could lead to sepsis in a critically ill patients with COVID-19. The role of ferritin as a biomarker of sepsis in those patients is yet fully understood. The aim of this study is to investigate an association between ferritin levels and sepsis in patients with COVID-19.

Method: This study was a retrospective, cross-sectional study of 474 COVID-19 hospitalized patients at Dr. M. Djamil Hospital, Padang.

Result: Most of the COVID-19 patients in this study were between the ages of 18 and 49 (38,61%), female (55.91%), with moderate clinical illness (40.50%), and had one comorbidity (41,14%) with obesity as the most common comorbidity (37.97%). More than half of patients (54,22%) had ferritin levels of ≥500 ng/mL (median 1,201 ng/mL with a range of 503–12,010 ng/mL). The incidence of sepsis was significantly higher in the group whose ferritin level was ≥ 500 ng/ml compared to those with less ferritin level (P<0.001; OR=3.33; 5.99% vs 17.91%; CI 95%=1.74-6.36).

Conclusion: There is a statistically significant association between the ferritin level and sepsis in patiens with COVID-19 at DR M Djamil Hospital.


COVID-19; ferritin; sepsis; pro-inflammatory; hyperferritinemia

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Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respir J. 2020;55(4):2000607.

Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: An overview. J Chin Med Assoc. 2020;83(3):217–20.

Global Sepsis Alliance. COVID-19/CORONA VIRUS/SARS-COV-2. 2020. p. 1–14.

Da Silva Ramos FJ, De Freitas FGR, MacHado FR. Sepsis in patients hospitalized with coronavirus disease 2019: How often and how severe? Curr Opin Crit Care. 2021;27(5):474–9.

Brandtner A, Tymoszuk P, Nairz M, Lehner GF, Fritsche G, Vales A, et al. Linkage of alterations in systemic iron homeostasis to patients’ outcome in sepsis: A prospective study. J Intensive Care. 2020;8:76.

Beltrán-García J, Osca-Verdegal R, Pallardó F V., Ferreres J, Rodríguez M, Mulet S, et al. Sepsis and coronavirus disease 2019: Common features and anti-inflammatory therapeutic approaches. Crit Care Med. 2020;48(12):1841–4.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054–62.

Banchini F, Cattaneo GM, Capelli P. Serum ferritin levels in inflammation: A retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients. World J Emerg Surg. 2021;16:9.

Bennett TD, Hayward KN, Farris RWD, Ringold S, Wallace CA, Brogan T V. Very high serum ferritin levels are associated with increased mortality and critical care in pediatric patients. Pediatr Crit Care Med. 2011;12(6):e233–6.

Garcia PCR, Longhi F, Branco RG, Piva JP, Lacks D, Tasker RC. Ferritin levels in children with severe sepsis and septic shock. Acta Paediatr. 2007;96(12):1829–31.

Abumayyaleh M, Nuñez-Gil IJ, El-Battrawy I, Estrada V, Becerra-Muñoz VM, Uribarri A, et al. Sepsis of patients infected by SARS-CoV-2: Real-world experience from the International HOPE-COVID-19-Registry and Validation of HOPE Sepsis Score. Front Med (Lausanne). 2021;8:728102.

Samuel M, Latha R, Kavitha K, Sivasubramanian V. A study on biomarkers of sepsis and potential role of procalcitonin and ferritin marker in diagnosis, prognosis and treatment. J Family Med Prim Care. 2022;11(6):2608–12.

Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics. 2014;6(4):748–73.

Sari EP, Medison I, Russilawati R. Association between feritine levels and severity of COVID19 in RSUP Dr. M. Djamil Padang. Jurnal Respirologi Indonesia. 2022;42(3):237–43.

Qin L, Li X, Shi J, Yu M, Wang K, Tao Y, et al. Gendered effects on inflammation reaction and outcome of COVID-19 patients in Wuhan. J Med Virol. 2020;92(11):2684–92.

Linarez Ochoa NE, Rodríguez G, Reyes ID, Rico Rivas KM, Ramírez C, Durón RM. Differences in inflammatory markers between coronavirus disease 2019 and sepsis in hospitalised patients. Clin Epidemiol Glob Health. 2022;15:101059.

Setiadi W, Rozi IE, Safari D, Daningrat WOD, Johar E, Yohan B, et al. Prevalence and epidemiological characteristics of COVID-19 after one year of pandemic in Jakarta and neighbouring areas, Indonesia: A single center study. PLoS One. 2022;17(5):e0268241.

McLaughlin KM, Bechtel M, Bojkova D, Münch C, Ciesek S, Wass MN, et al. COVID-19-related coagulopathy-is transferrin a missing link? Diagnostics (Basel). 2020;10(8):539.

Jing QL, Liu MJ, Zhang Z Bin, Fang LQ, Yuan J, Zhang AR, et al. Household secondary attack rate of COVID-19 and associated determinants in Guangzhou, China: a retrospective cohort study. Lancet Infect Dis. 2020;20(10):1141–50.

Indriyani N, Sabri YS, Afriani A. Association between comorbidities and outcome of COVID-19 patients at dr. M. Djamil General Hospital Padang. Respiratory Science. 2022;3(1):38–50.

Chicamy YA, Safitri A, Nindrea RD. Serum ferritin levels for the prediction of mortality among COVID-19 patients in an Indonesia’s National Referral Hospital. Open Access Maced J Med Sci. 2022;10(B):1056–61.

Liu T, Zhang J, Yang Y, Ma H, Li Z, Zhang J, et al. The role of interleukin‐6 in monitoring severe case of coronavirus disease 2019. EMBO Mol Med. 2020;12(7):e12421.

Chen J, Jiang Q, Xia X, Liu K, Yu Z, Tao W, et al. Individual variation of the SARS‐CoV‐2 receptor ACE2 gene expression and regulation. Aging Cell. 2020;19(7):e13168.

Lino K, Guimarães GMC, Alves LS, Oliveira AC, Faustino R, Fernandes CS, et al. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz J Infect Dis. 2021;25(2):101569.

Krishnan A, Hamilton JP, Alqahtani SA, A.Woreta T. A narrative review of coronavirus disease 2019 (COVID-19): Clinical, epidemiological characteristics, and systemic manifestations. Intern Emerg Med. 2021;16(4):815–30.

Cheng L, Li H, Li L, Liu C, Yan S, Chen H, et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal. 2020;34(10):e23618.

Ilham I, Anggrainy F, Mizarti D. Association between obesity and COVID-19 outcomes in the Intensive Care Unit of RSUP Dr. M. Djamil Padang. Jurnal Respirologi Indonesia. 2022;42(4):268–76.

Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, Vargas-Vázquez A, González-Díaz A, Márquez-Salinas A, et al. Predicting mortality due to SARS-CoV-2: A mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab. 2020;105(8):dgaa346.

Sawadogo W, Tsegaye M, Gizaw A, Adera T. Overweight and obesity as risk factors for COVID-19-associated hospitalisations and death: Systematic review and meta-analysis. BMJ Nutr Prev Health. 2022;5(1):10–8.

Surendra H, Elyazar IR, Djaafara BA, Ekawati LL, Saraswati K, Adrian V, et al. Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: A hospital-based retrospective cohort study. Lancet Reg Health West Pac. 2021;9:100108.

Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med. 2020;2(8):1069–76.

Osibogun A, Balogun M, Abayomi A, Idris J, Kuyinu Y, Odukoya O, et al. Outcomes of COVID-19 patients with comorbidities in southwest Nigeria. PLoS One. 2021;16(3):e0248281.

Kaushal K, Kaur H, Sarma P, Bhattacharyya A, Sharma DJ, Prajapat M, et al. Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis. J Crit Care. 2022;67:172–81.

Komariah N, Salbiah S, Nugroho BAA, Suliati S, Widiantari AD, Murtiani F. Ferritin level as independent predictor of Covid-19 : A cross sectional study. Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan. 2022;16(1):55–9.

Shang J, Ye G, Shi K, Wan Y, Luo C, Aihara H, et al. Structural basis of receptor recognition by SARS-CoV-2. Nature 2020 581:7807. 2020;581:221–4.

Ng WH, Tipih T, Makoah NA, Vermeulen JG, Goedhals D, Sempa JB, et al. Comorbidities in SARS-CoV-2 patients: A systematic review and meta-analysis. mBio. 2021;12(1):1–12.

Gómez-Pastora J, Weigand M, Kim J, Wu X, Strayer J, Palmer AF, et al. Hyperferritinemia in critically ill COVID-19 patients – Is ferritin the product of inflammation or a pathogenic mediator? Clin Chim Acta. 2020;509:249.

Suriawinata E, Mehta KJ. Iron and iron-related proteins in COVID-19. Clin Exp Med. 2023;23(4):969–91.

Koçak Tufan Z, Kayaaslan B, Mer M. COVID-19 and sepsis. Turk J Med Sci. 2021;51(SI-1):3301–11.

Patil M, Singh S, Henderson J, Krishnamurthy P. Mechanisms of COVID-19-induced cardiovascular disease, is sepsis or exosome the missing link? J Cell Physiol. 2021;236(5):3366–82.

Shappell CN, Klompas M, Kanjilal S, Chan C, Rhee C. Prevalence, clinical characteristics, and outcomes of sepsis caused by severe acute respiratory syndrome coronavirus 2 versus other pathogens in hospitalized patients with COVID-19. Crit Care Explor. 2022;4(5):E0703.

Chen HY, Tzeng IS, Tsai KW, Wu YK, Cheng CF, Lu KC, et al. Association between heme oxygenase one and sepsis development in patients with moderate-to-critical COVID-19: A single-center, retrospective observational study. Eur J Med Res. 2022;27(1):1–11.

Rajanna AH, Krishnegowda R, Govindaiah RM. To correlate serum ferritin levels with clinical outcome in Covid-19 patients. Asian J Med Sci. 2021;12(5):25.

Fang YP, Zhang HJ, Guo Z, Ren CH, Zhang YF, Liu Q, et al. Effect of serum ferritin on the prognosis of patients with sepsis: Data from the MIMIC-IV database. Emerg Med Int. 2022;2022:2104755–10.

Kaushal K, Kaur H, Sarma P, Bhattacharyya A, Sharma DJ, Prajapat M, et al. Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis. J Crit Care. 2022;67:172–81.

Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017;29(9):401–9.

Irvan, Febyan, Suparto. Sepsis dan tata laksana berdasar guideline terbaru Sepsis and Treatment based on The Newest Guideline. Jurnal Anestesiologi Indonesia. 2018;X(1):62–73.

Retamozo S, Brito-Zerón P, Sisó-Almirall A, Flores-Chávez A, Soto-Cárdenas MJ, Ramos-Casals M. Haemophagocytic syndrome and COVID-19. Clin Rheumatol. 2021;40(4):1233–44.



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Jurnal Respirologi Indonesia
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