ArticleJournal of clinical medicine2022
Extreme Hyperferritinemia: Causes and Prognosis.
Article in Journal of clinical medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 20 citations in OpenAlex.
- Hemophagocytic lymphohistiocytosis in critically ill patients: A guide for clinicians.World journal of critical care medicine · 2026Review
- Hyperferritinemia: Pathophysiology, Etiologies, and Diagnostic Approach.European journal of haematology · 2026Review
- Critical care outcomes of hemophagocytic lymphohistiocytosis in children: a single centre retrospective observational study.Pediatric rheumatology online journal · 2026Observational
- Real-world clinical outcomes of macrophage activation-like syndrome and hyperferritinemia in sepsis: a retrospective database analysis.EClinicalMedicine · 2026Article
- Comparative Clinical Characteristics of ICU and Non-ICU Hospitalized Patients With Human Anaplasmosis.Open forum infectious diseases · 2026Article
- Prevalence and Diagnostic Challenge of Hemophagocytic Lymphohistiocytosis Syndrome in Critically Ill Patients.European journal of haematology · 2026Article
- Article
- Etiologic spectrum and early mortality predictors in extreme hyperferritinemia: insights from rheumatology and hematology clinics.Clinical rheumatology · 2026Article
- Making every test count: Insights from a test kit efficiency audit.African journal of laboratory medicine · 2026Article
- Hyperinflammatory Syndrome of Unknown Origin Complicated by Shock, DIC, Intracranial Hemorrhage and Spontaneous Splenic Rupture: A Case Report.Clinical medicine insights. Case reports · 2026Article
- Macrophage P2Y12 regulates iron transport and its inhibition protects against atherosclerosis.Journal of advanced research · 2025Article
- Ferritin in Acute Myeloid Leukemia: Not Only a Marker of Inflammation and Iron Overload, but Also a Regulator of Cellular Iron Metabolism, Signaling and Communication.International journal of molecular sciences · 2025Review
- Toxicities Associated with CAR-T Cell Therapies.Mediterranean journal of hematology and infectious diseases · 2025Review
- Acute kidney injury in critical care: complications of hemophagocytic lymphohistiocytosis.Frontiers in immunology · 2024Review
- Hematologic cancers and infections: how to detect infections in advance and determine the type?Frontiers in cellular and infection microbiology · 2024Review
- Article
- Atypical Adult Still's Disease Complicated by Hemophagocytic Syndrome in an Older Patient: A Case Report.Cureus · 2023Article
- Normoferremia in Patients with Acute Bacterial Infections-A Hitherto Unexplored Field of the Dichotomy between CRP and Ferritin Expression in Patients with Hyper Inflammation and Failure to Increase Ferritin.International journal of molecular sciences · 2023Article
- Management of Complex Infections in Hemophagocytic Lymphohistiocytosis in Adults.Microorganisms · 2023Review
- Differential Diagnosis of Hyperferritinemia in Critically Ill Patients.Journal of clinical medicine · 2022Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The significance of extreme hyperferritinemia and its association with certain diagnoses and prognoses are not well characterized. We performed a retrospective analysis of adult patients with at least one total serum ferritin (TSF) measurement ≥ 5000 µg/L over 2 years, in three university hospitals. Conditions associated with hyperferritinemia were collected, and patients were classified into 10 etiological groups. Intensive care unit (ICU) transfer and mortality rates were recorded. A total of 495 patients were identified, of which 56% had a TSF level between 5000 and 10,000 µg/L. There were multiple underlying causes in 81% of the patients. The most common causes were infections (38%), hemophagocytic lymphohistiocytosis (HLH, 18%), and acute hepatitis (14%). For TSF levels > 10,000 µg/L, there were no solid cancer or hematological malignancy without another cause of hyperferritinemia. Isolated iron-overload syndromes never exceeded TSF levels > 15,000 µg/L. Extreme hyperferritinemia (TSF levels > 25,000 µg/L) was associated with only four causes: HLH, infections, acute hepatitis and cytokine release syndromes. A total of 32% of patients were transferred to an ICU, and 28% died. Both ICU transfer rate and mortality were statistically associated with ferritin levels. An optimized threshold of 13,405 μg/L was the best predictor for the diagnosis of HLH, with a sensitivity of 76.4% and a specificity of 79.3%. Hyperferritinemia reflects a variety of conditions, but only four causes are associated with extreme hyperferritinemia, in which HLH and acute hepatitis are the most common. Extreme hyperferritinemia has a poor prognosis with increased mortality.
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Registered trials
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