Atkinson and colleagues conducted a study recently to ascertain the prognostic ability of iron parameters in severe alcoholic hepatitis (sAH).

Investigators assessed the levels of serum ferritin, iron, transferrin, transferrin saturation, soluble transferrin receptor, nontransferrin-bound iron, and hepcidin in 828 sAH patients enrolled prospectively through the STOPAH trial. The study population was randomly segregated into an exploratory cohort with 200 patients and a validation cohort with 628 patients.

Patients with sAH were shown to have reduced serum transferrin and increased transferrin saturation. Baseline transferrin seemed to best predict 28-day and 90-day survival. The predictive ability of transferrin was comparable with the composite scores, including model of end-stage liver disease, Glasgow alcoholic hepatitis score, and discriminant function. Additionally, it had an independent association with survival in multivariable analysis.

The results were confirmed in the validation cohort. Transferrin was found to have no correlation with markers of liver synthesis or with non-transferrin-bound iron or soluble transferrin receptor (as markers of excess unbound iron and functional iron deficiency, respectively).

To conclude, among sAH patients, serum transferrin is a predictor of mortality with a performance comparable with commonly used composite scoring systems.

Source: Atkinson S, Hamesch K, Spivak I, et al. Serum Transferrin Is an Independent Predictor of Mortality in Severe Alcoholic Hepatitis. The American Journal of Gastroenterology 2020;115(3):398-405.