Association of Admission Serum Ferritin Levels with Disease Severity and Clinical Outcomes in Acute Infections: A Prospective Observational Study

Abstract

Background:Acute infections remain a significant cause of morbidity and mortality worldwide, often progressing to
severe systemic illness with organ dysfunction if not identified and managed promptly. Early identification of patients
at risk of severe disease is essential for timely intervention and improved outcomes. Serum ferritin, an intracellular
iron storage protein and acute phase reactant, has emerged as a potential biomarker reflecting inflammatory burden in
infectious conditions. Elevated ferritin levels have been reported in bacterial, viral, and systemic infections and may
correlate with disease severity and prognosis.
Objectives: To evaluate the association between admission serum ferritin levels and disease severity in patients with acute
infections and to assess its relationship with clinical outcomes including intensive care unit (ICU) admission, duration
of hospital stay, need for mechanical ventilation, and in-hospital mortality.
Methods: This prospective observational study included 180 adult patients admitted with acute infections to the Department
of General Medicine of a tertiary care teaching hospital over a period of 12 months. Patients aged ≥18 years with clinically
and laboratory-confirmed acute infections were enrolled after obtaining informed consent. Serum ferritin levels were
measured within 24 hours of admission using chemiluminescent immunoassay. Disease severity was assessed using
Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scoring systems. Clinical outcomes including
ICU admission, mechanical ventilation, length of hospital stay, and mortality were recorded. Statistical analysis was
performed using SPSS version 26.0, with p < 0.05 considered statistically significant.
Results: The mean age of study participants was 49.6 ± 16.2 years, with a male predominance (57.8%). The most common
acute infections included pneumonia, urinary tract infection, cellulitis, dengue, and sepsis of unknown origin. Mean
serum ferritin levels increased significantly with disease severity, measuring 248 ± 96 ng/mL in mild cases, 612 ± 188
ng/mL in moderate cases, and 1284 ± 410 ng/mL in severe cases (p < 0.001). Elevated ferritin levels were significantly
associated with ICU admission, prolonged hospital stay, need for mechanical ventilation, and in-hospital mortality. A
strong positive correlation was observed between serum ferritin and SOFA score (r = 0.68, p < 0.001).
Conclusion: Admission serum ferritin levels demonstrated a significant association with disease severity and adverse
clinical outcomes in patients with acute infections. Serum ferritin may serve as a practical, accessible, and cost-effective
adjunct biomarker for early risk stratification and prognostic assessment in acute infectious illnesses