Respiratory Research (Oct 2020)

Persisting alterations of iron homeostasis in COVID-19 are associated with non-resolving lung pathologies and poor patients’ performance: a prospective observational cohort study

  • Thomas Sonnweber,
  • Anna Boehm,
  • Sabina Sahanic,
  • Alex Pizzini,
  • Magdalena Aichner,
  • Bettina Sonnweber,
  • Katharina Kurz,
  • Sabine Koppelstätter,
  • David Haschka,
  • Verena Petzer,
  • Richard Hilbe,
  • Markus Theurl,
  • Daniela Lehner,
  • Manfred Nairz,
  • Bernhard Puchner,
  • Anna Luger,
  • Christoph Schwabl,
  • Rosa Bellmann-Weiler,
  • Ewald Wöll,
  • Gerlig Widmann,
  • Ivan Tancevski,
  • Judith-Löffler-Ragg,
  • Günter Weiss

DOI
https://doi.org/10.1186/s12931-020-01546-2
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 9

Abstract

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Abstract Background Severe coronavirus disease 2019 (COVID-19) is frequently associated with hyperinflammation and hyperferritinemia. The latter is related to increased mortality in COVID-19. Still, it is not clear if iron dysmetabolism is mechanistically linked to COVID-19 pathobiology. Methods We herein present data from the ongoing prospective, multicentre, observational CovILD cohort study (ClinicalTrials.gov number, NCT04416100), which systematically follows up patients after COVID-19. 109 participants were evaluated 60 days after onset of first COVID-19 symptoms including clinical examination, chest computed tomography and laboratory testing. Results We investigated subjects with mild to critical COVID-19, of which the majority received hospital treatment. 60 days after disease onset, 30% of subjects still presented with iron deficiency and 9% had anemia, mostly categorized as anemia of inflammation. Anemic patients had increased levels of inflammation markers such as interleukin-6 and C-reactive protein and survived a more severe course of COVID-19. Hyperferritinemia was still present in 38% of all individuals and was more frequent in subjects with preceding severe or critical COVID-19. Analysis of the mRNA expression of peripheral blood mononuclear cells demonstrated a correlation of increased ferritin and cytokine mRNA expression in these patients. Finally, persisting hyperferritinemia was significantly associated with severe lung pathologies in computed tomography scans and a decreased performance status as compared to patients without hyperferritinemia. Discussion Alterations of iron homeostasis can persist for at least two months after the onset of COVID-19 and are closely associated with non-resolving lung pathologies and impaired physical performance. Determination of serum iron parameters may thus be a easy to access measure to monitor the resolution of COVID-19. Trial registration ClinicalTrials.gov number: NCT04416100.

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