Increase in Serum Ferritin Level as a Marker of Disease Activity in Pediatric Sys-temic Lupus Erythematosus (pSLE) Patients
Serum Ferritin Level as a marker of disease activity in pSLE
Keywords:Ferritin, Pandemic, pSLE, SLEDAI
Ferritin is an acute-phase reactant that is elevated in autoimmune disorders, including systemic lupus erythematosus (SLE). However, their correlation with disease activity scores has not been confirmed. Pandemic Covid-19 makes children visitation to hospital to get the treatment of SLE were delayed. This study aimed to evaluate correlation between serum ferritin and disease activity and its role in screening for flare in pediatric SLE (pSLE) patients during pandemic Covid-19. This is a cross-sectional study conducted in Saiful Anwar General Hospital Malang. Sampling was carried out sequentially on pediatric patients who met the criteria for Systemic Lupus International Collaborating Clinics (SLICC) and were recorded between July 2021-May 2022. All patients were interviewed and assessed for disease activity using SLE Disease Activity Index 2000 (SLEDAI-2k). A score <4 was categorized as inactive disease. Biochemical, serological tests including markers of disease activity and ferritin level were measured by standard laboratory procedure. Comparison, correlation and ROC curve analyses were performed with SPSS software. There were 38 females pSLE participated in this study. The mean age of the patients were 12.6 ± 3.02 years. Serum ferritin significantly higher in active disease compared to inactive disease 84.50 ng/mL (68.00-151.75 ng/mL) ng/mL and 815.00 ng/mL (451.25-1570.00 ng/mL), a value of p<0.05 was determined to be statistically significant. A significant correlation was found between serum ferritin with SLEDAI 2K (r = 0.890, p = 0.000). Correlation was also found between serum ferritin and IgM anti-double stranded-DNA (r = 0.325, p = 0.046), but not with other laboratory and serological parameters. In ROC curve analysis, we found that Area Under The Curve (AUC) 0.989, 95%CI 0.964-1.014, p value 0,000, with cut off value 297.50 with sensitivity 85% and specificity 94.4%. Ferritin was increased in active disease as compared to inactive disease and correlated with SLEDAI score and IgM-dsDNA. Thus, ferritin may be potential as an affordable and available marker of disease activity in pSLE during pandemic Covid-19.
National Cancer Institute (2020) American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Definitions. doi: 10.32388/2SVGSG
Tsokos GC (2011) Systemic Lupus Erythematosus. New England Journal of Medicine 365 (22): 2110–2121. doi: 10.1056/NEJMra1100359.
Roberts I (2017) Nelson’s textbook of pediatrics (20th edn.), by R. Kliegman, B. Stanton, J. St. Geme, N. Schor (eds). Pediatric Radiology 47 (10): 1364–1365. doi: 10.1007/s00247-017-3907-9.
Almutairi N, Aljaser A, Almutairi A et al. (2020) Utility of serum ferritin and soluble interleukin-2 receptor as markers of disease activity in childhood systemic lupus erythematosus. International Journal of Pediatrics and Adolescent Medicine 7 (3): 112–115. doi: 10.1016/j.ijpam.2019.07.007.
Rathi M, Singh P, Bi HP et al. (2021) Impact of the COVID-19 pandemic on patients with systemic lupus er-ythematosus: Observations from an Indian inception co-hort. Lupus 30 (1): 158–164. doi: 10.1177/0961203320962855.
Tripathy R, Panda AK, Das BK (2015) Serum ferritin level correlates with SLEDAI scores and renal involve-ment in SLE. Lupus 24 (1): 82–89. doi: 10.1177/0961203314552290.
Santamaria-Alza Y, Sánchez-Bautista JD, Fajardo-Rivero J, Figueroa-Pineda CL (2018) SAT0464 Comparison of disease activity scores predicting mortality in patients with systemic lupus erythematosus in colombia. Annals of the Rheumatic Diseases 77 (Suppl 2): 1090–1091. doi: 10.1136/annrheumdis-2018-eular.7282.
Kell DB, Pretorius E (2014) Serum ferritin is an im-portant inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics 6 (4): 748–773. doi: 10.1039/C3MT00347G.
Mahmoud SS-E-D, Ghaith D, Farag Y, Ibrahim B (2018) Serum ferritin level as a marker of disease activity and re-nal involvement in Egyptian children with juvenile sys-temic lupus erythematosus. The Egyptian Rheumatologist 40 (4): 273–276. doi: 10.1016/j.ejr.2018.01.002.
Soliman SA, Haque A, Mason S et al. (2021) Cross-sectional study of plasma Axl, ferritin, IGFBP4 and sTNFR2 as biomarkers of disease activity in childhood-onset SLE: A study of the Pediatric Nephrology Research Consortium. Lupus 30 (9): 1394–1404. doi: 10.1177/09612033211016100.
Gamal NM, Khedr TM, Ismail NM et al. (2020) Is it useful to measure serum ferritin level in systemic lupus erythematosus patients? The Egyptian Rheumatologist 42 (1): 17–21. doi: 10.1016/j.ejr.2019.04.007.
Hesselink DA, Aarden LA, Swaak AJG (2003) Profiles of the acute‐phase reactants C‐reactive protein and ferritin related to the disease course of patients with systemic lu-pus erythematosus. Scandinavian Journal of Rheumatolo-gy 32 (3): 151–155. doi: 10.1080/03009740310002489.
Andreas H, Zubir Z, Gatot D et al. (2020) The Levels of Ferritin Serum as a Biomarker to Distinguish Between Active and Inactive Systemic Lupus Erythematosus. In-ternational journal of Research science and Management 7 (7): 28–34. doi: 10.29121/ijrsm.v7.i7.2020.5.
Smitherman EA, Cron RQ (2021) Hyperferritinemia Wins Again: Defining Macrophage Activation Syndrome in Pediatric Systemic Lupus Erythematosus. The Journal of Rheumatology 48 (9): 1355–1357. doi: 10.3899/jrheum.210024.
Zandman-Goddard G, Shoenfeld Y (2007) Ferritin in autoimmune diseases. Autoimmunity Reviews 6 (7): 457–463. doi: 10.1016/j.autrev.2007.01.016
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