Skip to main content

Evaluation of iron, transferrin and ferritin serum levels in patients with severe sepsis and septic shock


Iron metabolism is altered in critically ill patients leading to hypoferremia. Several studies related it to inflammatory response [1, 2]. The present study aims to evaluate iron, transferrin and ferritin serum levels in patients with severe sepsis and septic shock and its association with severity of organ dysfunction.


A prospective observational cohort study, unicentric, in a tertiary teaching hospital. From November 2010 to October 2011 patients over 18 years old with severe sepsis or septic shock with up to 72 hours of organ dysfunction were included. Exclusion criteria were blood transfusion or iron supplementation in the last 90 days, previous inclusion and pregnancy. After obtaining informed consent, blood samples were taken at baseline and on day 7. Demographic and APACHE II and SOFA data were also collected. Patients who were transfused with red blood cells between the two periods were excluded from the day 7 sample. Patients were followed until hospital discharge or death.


Thirty patients were included, with a mean age of 59.6 ± 19.3, APACHE II score 19.1 ± 7.2, SOFA at baseline 8.5 ± 4.0, and most patients had septic shock (63.3%). Baseline iron and transferrin levels were low in 83.3% (14.0 (5.0 to 25.5)) and in 96.7% (94.1 ± 31.6) of the patients, while ferritin was high in 63.3% (954.0 (508.4 to 5,394.0)). In the 19 patients where a day 7 sample was available, variation between baseline and day 7 was statistically significant for transferrin (97.9 ± 37.5 to 132.7 ± 48.3, P = 0.013) and ferritin (478.0 (224.5 to 1,741.0) to 376.0 (187.0 to 886.7), P = 0.018), while iron levels showed a trend towards increasing levels at day 7 (17.0 (6.5 to 44.3) to 29.0 (21.0 to 54.0), P = 0.061). Baseline SOFA score trends to be lower in hypoferrinemic patients (7.7 ± 3.8 vs. 12.4 ± 1.9, P = 0.098). The Spearman test showed a weak correlation only between SOFA and iron levels (P = 0.008; r2 = 0.48).


Septic patients have low iron and transferrin levels, associated with high ferritin levels, and those levels improved during the course of disease. Low iron levels might be associated with low SOFA scores.


  1. 1.

    Lagan AL, et al.: Am J Physiol Lung Cell Mol Physiol. 2008, 294: L161-L174.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Quinlan GJ, et al.: Am J Respir Crit Care Med. 1997, 155: 479-484.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information



Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Missano Florido, M., Assunção, M., Mazza, B. et al. Evaluation of iron, transferrin and ferritin serum levels in patients with severe sepsis and septic shock. Crit Care 16, P424 (2012).

Download citation

  • Published:

  • DOI:


  • Septic Shock
  • Ferritin
  • Transferrin
  • Severe Sepsis
  • Organ Dysfunction