DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182042

Evaluation of serum hepcidin as a biochemical marker in diagnosis of anemia of chronic disease

Sonal Vyas, Sanjeev Suman, Anil Kapoor, S. K. Nema

Abstract


Background: Anemia is a serious public health problem. It affects two billion people worldwide, particularly infants and young children mainly in developing countries where its etiology is multifactorial. Anemia in infancy is generally associated with impaired cognitive and behavioral development, impaired oxygen transport and a poorer prognosis in the context of many chronic diseases or chronic infections. The Present study aims to detect the serum hepcidin and ferritin levels in chronic disease anemia and correlate the values of serum hepcidin levels with their serum ferritin levels and IL-6 levels.

Methods: A total of 86 individuals were enrolled in the study. Sample for hematological evaluations were collected and estimation was carried out for biomarker estimation by ELISA method(s) using specified kit(s) procured commercially. The statistical evaluation was done using SPSS version 24.0. Analysis of variance (ANOVA) and Pearson's correlation tests were used to compare the variables and to see the correlation between the different variables.

Results: In present study, we observed statistically significant lower values of RBC count, Hbgm/dl, MCV, MCH, MCHC in ACD group than the normal group. For serum hepcidin when ROC curves and Pearson’s scattered plot were made in case of ACD group; the ROC was recorded to be maximum >0.869; with a sensitivity of 84.62% and specificity 94.12% while the confidence level was 95% with an interval of 0.779 to 0.932. Further, the cutoff point determined was >72.93. Thus, the hepcidin level > 72ng/mL and above is related to the ACD. These cut off points had strong confidence interval and valuable predictive potential.

Conclusions: Serum Hepcidin can be used as a simple and cost effective diagnostic marker for identification of anemia.


Keywords


Anemia of chronic disease (ACD), IL-6, Serum hepcidin, Serum ferritin

Full Text:

PDF

References


WHO/CDC. Assessing the Iron Status of Populations. Second Edition, Including Literature Reviews. Geneva: 2007.

Lokeshwar MR, Mehta M, Mehta N, Shelke P, Babar N. Prevention of Iron Deficiency Anemia (IDA): How Far Have We Reached? Indian J of Pediatrics. 2011;78(5):593-602.

Milman N. Anemia SA. Major Health Problem in Many Parts of the World. Annuals Hematology. 2011;90(4):369-77.

Walter T, Andraca I, Chadud P, Perales CG. Iron Deficiency Anemia: Adverse Effects on Infant Psychomotor Development. Pediatrics. 1989;84(1):7-17.

Rao R, Georgieff MK. Perinatal Aspects of Iron Metabolism. Acta Paediatrica. 2002;91(438):124-9.

Cullis JO. Diagnosis and Management of Anaemia of Chronic Disease: Current Status. British J Haematology. 2011;154(3):289-300.

Xu M. Kashanchi F, Foster A, Rotimi J, Turner W, Gordeuk VR, Nekhai S. Hepcidin Induces HIV-1 Transcription Inhibited by Ferroportin. Retrovirology. 2010;7:104.

Drakesmith H, Prentice A. Viral Infection and Iron Metabolism. Nature Rev. Microbiology. 2008;6(7):541-52.

Nemeth E, Tuttle MS, Powelson J, Vaughn MB, Donovan A, Ward DM, et al. Hepcidin Regulates Cellular Iron Efflux by Binding to Ferroportin and Inducing its Internalization. Science. 2004;306(5704):2090-3.

Vyas S, Kapoor A, Nema SK, Suman S. Quantification of serum hepcidin as a potential biomarker in diagnosis of iron deficiency anemia. Int J Res Med Sci. 2017;5:2926-30.

Kroot JJ, Van Herwaarden AE, Tjalsma H, Jansen RT, Hendriks JC, Swinkels DW. Second Round Robin for Plasma Hepcidin Methods: First Steps Toward Harmonization. Amer J Hematology. 2012;87(10):977-83.

Galesloot TE, Vermeulen SH, Geurts-Moespot AJ, Klaver SM, Kroot JJ, Van Tienoven D, et al. Reference Ranges and Biochemical Correlates in the General Population. Blood. 2011;117(25):E218-225.

Ganz, T, Olbina, G, Girelli, D, Nemeth, E. and Westerman, M. Immunoassay for human serum hepcidin. Blood. 2008;112(10):4292-7.

Swinkels DW. Serum hepcidin: reference ranges and biochemical correlates in the general population. Blood. 2011;117(25):e218-225.

Grebenchtchikov N, Geurts-Moespot AJ, Kroot JJ, den Heijer M, Tjalsma H, Swinkels DW, et al. High-sensitive radioimmunoassay for human serum hepcidin. Brit J of Haemat. 2009;146(3):317-25.

Galesloot TE, Vermeulen SH, Geurts-Moespot AJ, Klaver SM, Kroot JJ, van Tienoven D, et al. Serum hepcidin: reference ranges and biochemical correlates in the general population. Blood. 2011;117(25):e218-225.

Kroot JJ, Laarakkers CM, Geurts-Moespot AJ, Grebenchtchikov N, Pickkers P, van Ede AE, et al. Immunochemical and massspectrometry-based serum hepcidin assays for iron metabolism disorders. Clinical Chemistry. 2010;56(10):1570-9.

Trinder D, Ayonrinde OT, Olynyk JK. Iron, and Oxidative Stress: The New Choreography of Hepcidin. Gastroenterology. 2008;134(1):348-51107.

Rehu M, Punnonen K, Ostland V, Heinonen S, Westerman M, Pulkki K, et al. Maternal serum hepcidin is low at term and independent of cord blood iron status. Euro J of Haemat. 2010;85(4):345-52.

Muller KF, Lorenz L, Poets CF, Westerman M, Franz AR. Hepcidin concentrations in serum and urine correlate with iron homeostasis in preterm infants. The J of Pediat. 2012;160(6):949-53.

Young MF, Griffin I, Pressman E, McIntyre AW, Cooper E, McNanley T, et al. Maternal hepcidin is associated with placental transfer of iron derived from dietary heme and nonheme sources. The J of Nutrit. 2012;142(1):33-9.

Cheng PP, Jiao XY, Wang XH, Lin JH, Cai YM. Hepcidin Expression in Anemia of Chronic Disease and Concomitant Iron­Deficiency Anemia. Clin Exp Med. 2011;11:33-42.

Theurl I, Aigner E, Theurl M, Nairz M, Seifert M, Schroll A, et al. Regulation of Iron Homeostasis in Anemia of Chronic Disease and Iron Deficiency Anemia: Diagnostic and Therapeutic Implications. Blood. 2009;113:527-8.

Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK, et al. Il-6 Mediates Hypoferremia of Inflammation by Inducing the Synthesis of The Iron Regulatory Hormone Hepcidin. J Clin Invest. 2004;113:1271-6.

Kato A, Tsuji T, Luo J, Sakao Y, Yasuda H, Hishida A. Association of Prohepcidin and Hepcidin­25 with Erythropoietin Response and Ferritin in Hemodialysis Patients. Am J Nephrol. 2008;28:115-21.

Pak M, Lopez Ma, Gabayan V, Ganz T, Rivera S. Suppression of hepcidin during anemia requires erythropoietic activity. Blood. 2006;108(12):3730-5.

Pasricha SR, Mcquilten Z, Westerman M, Keller A, Nemeth E, Ganz T, et al. Serum hepcidin as a diagnostic test of iron deficiency in premenopausal female blood donors. Haematologica. 2011;96(8):1098-105.