Admission ferritin in cardiogenic shock predicts mortality in the CVICU

Although several studies have evaluated the prognostic value of inflammation in cardiogenic shock (CS), none have assessed the role of ferritin. Serum ferritin, commonly used as an indicator of iron status, also rises in response to an inflammatory insult and has recently been associated with worse outcomes in STEMI.

The purpose of this study is to investigate the prognostic value of admission ferritin levels in predicting short-term mortality among patients with CS admitted to the CVICU.

This is a retrospective study of patients with CS admitted to the CVICU at our institution between 2023 and 2024. Patients were included if they were >18 years old, had a diagnosis of CS during the index hospitalization, and had a ferritin value measured on admission. The primary outcome was to evaluate the association between initial serum ferritin ≥300 ng/mL and mortality in the CVICU.

A total of 384 patients were included with a median follow-up of 12 days (IQR 6–19). Median ferritin level was 349 ng/mL (IQR 162–799), and the median time to ferritin measurement after admission was 1 day (IQR 1–2). The median age was 62 years; 47.1% had hypertension, 44.7% diabetes, 32.2% chronic heart failure (HF), and 84.7% had AMI-related CS. Patients with ferritin ≥300 ng/mL had a significantly higher prevalence of diabetes, dyslipidemia, acute kidney injury, white blood cell count, lactate, ALT, and hsCRP levels, but a lower prevalence of chronic HF and prior SGLT2i use (all p<0.05). No other significant differences were found between groups. Elevated ferritin (≥300 ng/mL) was associated with higher mortality (OR 1.88, 95% CI 1.14–3.11, p=0.017), which remained significant after adjustment for classical cardiovascular risk factors (adjusted OR 1.97, 95% CI 1.18–3.30, p=0.022) and inflammatory biomarkers (adjusted OR 1.24, 95% CI 1.01–1.53, p=0.011). At 30 days, there was a trend toward higher mortality among patients with ferritin ≥300 ng/mL (HR 1.47, 95% CI 0.93–2.31, p=0.08). Finally, mortality increased progressively across ferritin quartiles (3.6%, 4.7%, 5.5%, and 8.6%; p=0.007).

In patients with CS, elevated ferritin (≥300 ng/mL) was an independent predictor of short-term mortality in the CVICU, regardless of the presence of classical cardiovascular risk factors and other inflammatory markers. Further studies are warranted to clarify the role of ferritin as a prognostic biomarker in CS.