Role of Serum ferritin as a marker of decompensated cirrhosis and its correlation with CTP, MELD and MELD-Na scores

Objectives: Liver cirrhosis, when decompensated; is associated with considerable morbidity and mortality. Scoring systems used to define the severity of cirrhosis and predict mortality include several clinical and biochemical parameters. Serum ferritin is a universally available biomarker, elevated in inflammatory conditions including hepatic necroinflammation. The study aimed to analyze whether serum ferritin has a role as a biomarker of decompensation and correlation with severity in cirrhotic patients.
Methods: 131 patients with cirrhosis; both compensated and decompensated admitted at Gastroenterology, BIRDEM General Hospital, Dhaka, Bangladesh from November 2019 to March 2022 were included in this cross-sectional study. To determine severity, Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) and MELD-sodium (MELD-Na) were estimated. Comparison of ferritin between and among different groups was done and the relationship with severity was assessed.
Results: Serum ferritin was significantly higher in decompensated (mean 474.20±769.53 ng/mL) than in compensated (80.85±35.31) cirrhosis patients (P<0.001). Ferritin levels among different CTP grading differed significantly (P<0.001). It was higher in grade C (694.14±975.57) than in grade B (213.02±219.17) and A (80.85±35.31) as per pairwise comparison. Moderate positive correlations were observed between ferritin and MELD along with MELD-Na scores. Receiver operating characteristic (ROC) analysis of serum ferritin for predicting hepatic decompensation gave a significant area under the curve (AUC) value (0.821) and the best cut-off value was 105.5 ng/mL (sensitivity 76.2%, specificity 84.6%).
Conclusion: The study suggests serum ferritin can be used as an alternate biomarker for screening hepatic decompensation and stratifying severity.