Prognostic Value of Serum Iron, Ferritin, and Transferrin in Chronic Alcoholic Liver Disease

  • Ivan Ribot-Hernández
  • Candelaria Martín-González
  • Víctor Vera-Delgado
  • Lourdes González-Navarrete
  • José Fernando de Armas-González
  • José Viña-Rodríguez
  • María José Sánchez-Pérez
  • Melchor Rodríguez-Gaspar
  • Emilio González-ReimersEmail author


Ethanol increases iron absorption. Therefore, increased amount of iron reaches the liver, and exerts pro-oxidant effects and stimulates ferritin synthesis and hepatic stellate cell activation, promoting fibrosis and inflammation. These mechanisms would theoretically support a role of ferritin as a marker of the transition to liver cirrhosis, and, consequently, as a prognostic factor, but there is controversy regarding its behavior in alcoholics. We analyzed among 238 severe alcoholics the prognostic value of iron, ferritin, transferrin, transferrin saturation index (TSI) and total iron binding capacity (TIBC), and the relationships of these variables with liver function, proinflammatory markers (C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor α), and the presence of cirrhosis. Patients showed higher serum ferritin (Z = 2.50, p = 0.031) but lower transferrin (t(264) = 4.81, p < 0.001), TIBC (t(262) = 4.44, p < 0.001), and iron (Z = 3.19, p = 0.001) values compared with 32 age- and sex-matched controls. Ferritin was related to inflammatory cytokines such as IL-8 (ρ = 0.18, p = 0.012) and to IL-6 (ρ = 0.16, p = 0.016), but not to liver function. On the contrary, cirrhotics showed lower transferrin (t(234) = 4.77, p < 0.001) and TIBC (t(232) = 4.67, p < 0.001), but higher TSI (Z = 3.35, p < 0.001) than non-cirrhotics. Transferrin, TSI, and TIBC were related to liver function impairment (marked differences among the Child’s groups regarding transferrin (KW (2) = 22.83, p < 0.001), TSI (KW (2) = 15.81, p < 0.001), and TIBC (KW (2) = 21.38, p < 0.001) but only weakly to inflammation (inverse relationships between IL-6 and total iron (ρ = − 0.16, p = 0.017), TIBC (ρ = − 0.20, p = 0.002), and transferrin (ρ = − 0.20, p = 0.003). In accordance, albumin, IL-6, alcohol quitting, and TSI, in this order, were independently related to mortality, but not ferritin or iron.


Cirrhosis Alcoholism Iron Ferritin Transferrin Proinflammatory cytokines 


Compliance with Ethical Standards

The study protocol was approved by the local ethical committee of our Hospital (CHUC_2019_83) and conforms to the ethical guidelines of the 1975 Declaration of Helsinki. All the patients gave their written informed consent.

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ivan Ribot-Hernández
    • 1
  • Candelaria Martín-González
    • 1
  • Víctor Vera-Delgado
    • 1
  • Lourdes González-Navarrete
    • 1
  • José Fernando de Armas-González
    • 1
  • José Viña-Rodríguez
    • 1
  • María José Sánchez-Pérez
    • 1
  • Melchor Rodríguez-Gaspar
    • 1
  • Emilio González-Reimers
    • 1
    Email author
  1. 1.Servicio de Medicina Interna Hospital Universitario de CanariasUniversidad de La LagunaTenerifeSpain

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