Elevated serum ferritin as a predictor of complications in cirrhotic patients: a retrospective cohort study

Cirrhosis is a major cause of morbidity and mortality worldwide [1]. While serum ferritin is recognized as a marker of liver injury and inflammation, its prognostic value for cirrhosis-related complications is not well established. We investigated whether serum ferritin levels could predict complications in cirrhotic patients. In this retrospective observational cohort study, which included both descriptive and analytical components, serum ferritin levels were measured in adult cirrhotic patients admitted to the gastroenterology department of a University Hospital Center between March 2017 and March 2024. The normal reference range was defined as 22–275 ng/mL for men and 4.63–204 ng/mL for women. Patients were monitored for the occurrence of complications over a one-year period. Statistical analyses were performed to assess the association between serum ferritin levels and complications, and to determine whether elevated ferritin was an independent predictor of adverse outcomes. The study included 200 cirrhotic patients (111 females and 89 males) with a mean age of 58,06 ± 15.21 years (range: 19–95). The most common etiologies were metabolic-associated steatohepatitis (MASH) (49.7%) and viral hepatitis (19%). Serum ferritin levels were significantly higher in decompensated patients compared to compensated patients (173 ± 295.22 ng/mL vs. 121.32 ± 251.98 ng/mL). During one-year follow-up, 68.5% of patients with elevated ferritin levels developed complications, compared to 27.7% of those with normal ferritin levels. Serum ferritin levels were significantly higher in Child-Pugh B patients (424.9 ng/mL) compared to Child-Pugh A (74.8 ng/mL, p = 0.002). Receiver operating characteristic (ROC) curve analysis demonstrated that serum ferritin has moderate discriminative power in predicting the occurrence of complications in cirrhotic patients (AUC = 0.670). Elevated ferritin (≥ 45 ng/mL) was associated with a significantly increased risk of complications (p < 0.001). Multivariate analysis revealed the following predictors of hepatic decompensation: elevated serum ferritin (aOR 5.76, 95% CI 2.08–15.90, p = 0.001), hyponatremia (aOR 0.39, 95% CI 0.18–0.85, p = 0.017), and vitamin D deficiency (aOR 6.52, 95% CI 1.86–22.92, p = 0.003). These findings highlight the complex and multifactorial nature of hepatic decompensation and support the inclusion of serum ferritin in a comprehensive prognostic assessment. Elevated serum ferritin levels are independently associated with an increased risk of complications in cirrhotic patients. Given its wide availability and low cost, serum ferritin may serve as a simple prognostic biomarker to guide risk assessment and optimize clinical management in this population.