HYPERFERRITINEMIA IN CRITICALLY ILL PATIENTS – A SINGLE CENTER STUDY

Abstract

Objective: Our research is an evaluation of ferritin concentrations to distinguish between hemophagocytic lymphohistiocytosis and other causes of hyperferritinemia in a mixed group of critically ill individual’s adverse outcomes in the critical-care setting.

Study Design and Setting: This was a Retrospective observational done in the Intensive Care Units (ICUs) of Shifa International Hospital, Islamabad, from October 2025 to January 2026.

Methodology:  Non-probability consecutive sampling was used to enroll 150 critically ill patients. Hyperferritinemia was defined to be serum ferritin of 500 ng/mL and above. The association of high serum ferritin levels with derangement in key laboratory parameters, organ dysfunction scores, and major clinical outcomes was determined using the Chi-square test or Fisher exact test between categorical variables, as applicable, and p was determined to be statistically significant if value ≤0.05.

Results: 150 critically ill patients with hyperferritinemia were studied (mean age 54.2 +16.8 years). Patients with ferritin >2000 ng/mL had significantly higher CRP (138.7 ± 61.2 vs 104.3 ± 49.6 mg/L; p = 0.01). They also required more frequent mechanical ventilation (82.9% vs 65.0%; p = 0.01), had longer ICU stays (median 12 vs 9 days; p = 0.03), and higher 30-day mortality (45.7% vs 28.8%; p = 0.02). The diagnosis of hemophagocytic lymphohistiocytosis (HLH) occurred in 12.0% of the patients, and carried a higher mortality rate than non-HLH (61.1 vs 33.3; p = 0.02).

Conclusion: Marked hyperferritinemia (>2000 ng/mL) is a robust independent predictor of extreme systemic inflammation, dysfunction of multiple organs, and elevated mortality in critically ill patients.