Persisting alterations of iron homeostasis in COVID-19 are associated with non-resolving lung pathologies and poor patie
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RESEARCH
Persisting alterations of iron homeostasis in COVID‑19 are associated with non‑resolving lung pathologies and poor patients’ performance: a prospective observational cohort study Thomas Sonnweber1 , Anna Boehm1, Sabina Sahanic1, Alex Pizzini1, Magdalena Aichner1, Bettina Sonnweber2, Katharina Kurz1, Sabine Koppelstätter1, David Haschka1, Verena Petzer3, Richard Hilbe1, Markus Theurl4, Daniela Lehner4, Manfred Nairz1, Bernhard Puchner5, Anna Luger6, Christoph Schwabl6, Rosa Bellmann‑Weiler1, Ewald Wöll2, Gerlig Widmann6, Ivan Tancevski1, Judith‑Löffler‑Ragg1 and Günter Wei ss1,7*
Abstract Background: Severe coronavirus disease 2019 (COVID-19) is frequently associated with hyperinflammation and hyperferritinemia. The latter is related to increased mortality in COVID-19. Still, it is not clear if iron dysmetabolism is mechanistically linked to COVID-19 pathobiology. Methods: We herein present data from the ongoing prospective, multicentre, observational CovILD cohort study (ClinicalTrials.gov number, NCT04416100), which systematically follows up patients after COVID-19. 109 participants were evaluated 60 days after onset of first COVID-19 symptoms including clinical examination, chest computed tomography and laboratory testing. Results: We investigated subjects with mild to critical COVID-19, of which the majority received hospital treatment. 60 days after disease onset, 30% of subjects still presented with iron deficiency and 9% had anemia, mostly catego‑ rized as anemia of inflammation. Anemic patients had increased levels of inflammation markers such as interleukin-6 and C-reactive protein and survived a more severe course of COVID-19. Hyperferritinemia was still present in 38% of all individuals and was more frequent in subjects with preceding severe or critical COVID-19. Analysis of the mRNA expression of peripheral blood mononuclear cells demonstrated a correlation of increased ferritin and cytokine mRNA expression in these patients. Finally, persisting hyperferritinemia was significantly associated with severe lung pathologies in computed tomography scans and a decreased performance status as compared to patients without hyperferritinemia.
*Correspondence: guenter.weiss@i‑med.ac.at 1 Department of Internal Medicine II, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria Full list of author information is available at the end of the article © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your
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