Hepcidin Based Treatment of ICU Patients with Iron Deficiency Anemia Reduced Mortality and Improved 1-Year Survival

A recent study of critically ill ICU patients diagnosed with iron deficiency (ID) anemia showed that measuring hepcidin in the blood before treatment with intravenous (IV) iron improved the outcome compared to the control patients, where treatment was based on standard of care.

The authors stated that diagnosing ID anemia is challenging because it is often difficult to interpret ferritin and transferrin saturation results, common markers of iron balance, in the presence of inflammation, commonly observed in critically ill patients. Since hepcidin is the key regulator of iron metabolism, the study aimed to assess hepcidin’s utility in diagnosis and treatment of the ICU patients who were ready to be discharged from the hospital. Patients in the intervention group were treated for ID with either IV iron only or with IV iron and erythropoietin (EPO), based on their hepcidin measurements. Patients in the control group were treated based on standard of care, without measuring hepcidin. Each group had about 200 assigned patients.

The results indicated that two of the measured outcomes were improved in the intervention group, the ICU patients who were treated for ID with either IV iron only or with IV iron and EPO based on their hepcidin measurements. First, they had a significantly lower mortality rate 90 days post-ICU discharge compared to the control group (50% decrease, or 16 deaths vs 33 deaths in control group) and second, they had better 1-year survival. In addition, the study revealed that measuring hepcidin yielded significantly more ICU patients diagnosed with ID compared with patients diagnosed using the standard laboratory tests (50% patients diagnosed with ID vs less than 10%).

The results of this controlled, single-blinded multicenter study were published by Lasocki et al. in Critical Care, 25: 62, (2021) and they support the use of hepcidin as a valuable diagnostic marker, as well as using hepcidin as a guide for treatment of ID.

Reference:

Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

Lasocki S, Asfar P, Jaber S, Ferrandiere M, Kerforne T, Asehnoune K, Montravers P, Seguin P, Peoc’h K, Gergaud S, Nagot N, Lefebvre T, Lehmann S; Hepcidane* study group. Crit Care. 2021 Feb 15; 25(1):62