Clinical significance of increased hepcidin expression in patients with anemia of chronic diseases with iron deficiency

Background. Therapy of iron deficiency is of great clinical importance in improving the quality of life of patients with chronic inflammatory diseases. Determining the hepcidin level and iron metabolism parameters in such patients are a diagnostically important both for determining the pathogenesis of anemia, as well as for a further personalized approach to correcting iron deficiency. Objective. Investigation of the serum hepcidin level and iron metabolism indicators in patients with various types of anemia, and determination of the severity of anemia based on the hepcidin level and the severity of iron deficiency. Methods. The study included 104 patients with mild to moderate anemia: 35% men and 69% women with laboratory-confirmed anemia of varying severity, including 25 (24%) patients with IDA, 36 (35%) with ACD and ID, and 43 (41%) with ACD. The patients underwent a clinical blood test, and determination of the parameters of iron metabolism: serum iron, TSF, ferritin and hepcidin level. Results. In patients with IDA, a significant relationship between the anemia severity and the TSF (AUC 0.986) and ferritin (AUC 0.689) levels was noted; the critically significant TSF level for the development of moderate anemia was 7.2% and for below 19 pg/l. In patients with ACD and ID, a statistically significant dependence was found only on the hepcidin level (AUC 0.647), with an increase in hepcidin of more than 16 ng/ml. For the ferritin and transferrin levels, no statistically significant relationship was found, and the AUC values for these indicators were lower compared to the AUC of hepcidin. In patients with ACD, there was a high correlation with the hepcidin level AUC (0.823), with hepcidin level more than 20 ng/ml and an increase in ferritin of485 pg/l (AUC 0.808). Conclusion. The results of the study confirmed the relationship between the anemia severity and the level of inflammatory markers and the degree of inflammatory response in patients with anemia of chronic diseases. Such pathogenesis of ACD dictates further choice of tactics for its treatment, namely, the appointment of a combination therapy with iron preparations and anticytokine drugs.

anemia, iron deficiency, anemia of chronic diseases, hepcidin