Serum ferritin as an independent risk factor for severity in COVID-19 patients

Serum ferritin as an independent risk factor for severity in COVID-19 patients.
Serum ferritin is an iron storage protein that is widely measured as an indicator of iron status, but it is also a well-known inflammatory marker.
The mechanisms responsible for the association of hyperferritinemia and disease severity in patients with COVID-19 are :

  1. Proinflammatory cytokines such as interleukin-Iβ (IL-lβ), tumor necrosis factor-a (TNF-α), and IL-6 may increase ferritin synthesis.
  2. The cellular damage derived from inflammation can promote the leakage of intracellular ferritin, thus elevating serum ferritin.
  3. In acidosis, the microvascular environment and increased production of reactive oxygen species (ROS) might liberate iron from ferritin, and it is this unliganded iron that can participate in Haber-Weiss and Fenton reactions, creating hydroxyl radicals,causing further cellular damage,and worsening tissue injury, thus causing a vicious cycle of inflammation.