• Naseer Umer Services Hospital Lahore
  • Mujeeb Ullah Makki Services Hospital Lahore
  • Shagufta Kunwal Kiran Ittefaq Hospital Lahore
  • Nauman Arif Jadoon Ittefaq Hospital Lahore


Background: Serum ferritin is marker for hepatic neco-inflammation and known 1 year mortality predictor in post-transplant patients. However, data on utility as early mortality predictor in patient of cirrhosis is scarce. We investigated whether ferritin can be used as one month mortality predictor in patients of decompensated cirrhosis. Methods: The study cohort included 132 patients in whom predictors of mortality were studied. Results: One hundred and thirty-two patients with 77 (58.33%) male with a mean age of 54 (±8.3) years with decompensated cirrhosis were followed for 30 days. enrolled for study. Majority of the patients had hepatitis C (71.4%) with 19 (14.3%) cases of hepatitis B related cirrhosis and 5.3%, 4.5% and 2.3% comprising alcoholic, autoimmune and Wilsons related decompensated cirrhosis respectively. Ninety-one (69.42%) patients were alive at end of study period, with serum ferritin levels were significantly different between the survivors and the non-survivors (p< .001) and showed significant correlation with CTP Score (p <.001) and MELD Score (p <.001). Regarding ferritin level and outcome, 76 (all alive) had ferritin level <200 ng/ml, 26 (13 alive, 13 died) had ferritin level between 200–400 ng/ml and 30 (2 alive, 28 died) had ferritin level >400 ng/ml (p= .001). With increasing ferritin level, CTP class as well as MELD score increased. Patients with raised ferritin levels were more likely to die compared to those with lower ferritin levels (p <.001). Conclusion: Serum ferritin levels correlate with severity of liver disease and are associated with early mortality in patients of decompensated cirrhosis independent of MELD score.Keywords: Ferritin; Predictor; Chronic liver disease

Author Biographies

Naseer Umer, Services Hospital Lahore

Psot Graduate ResidentMedical Unit-IIIServices Hospital Lahore

Mujeeb Ullah Makki, Services Hospital Lahore

Psot Graduate ResidentMedical Unit-IIIServices Hospital Lahore

Shagufta Kunwal Kiran, Ittefaq Hospital Lahore

Psot Graduate ResidentMedical DepartmentIttefaq Hospital Lahore

Nauman Arif Jadoon, Ittefaq Hospital Lahore

Psot Graduate ResidentMedical DepartmentIttefaq Hospital Lahore


Schuppan D, Stolzel U, Oesterling C, Somasundaram R. Serum assays for liver fibrosis. J Hepatol 1995;22(2 Suppl):82–8.

Keeffe EB. Summary of guidelines on organ allocation and patient listing for liver transplantation. Liver Transpl Surg 1998;4(5Suppl 1):S108–14.

Oellerich M, Burdelski M, Lautz HU, Binder L, Pichlmayr R. Predictors of one-year pretransplant survival in patients with cirrhosis. Hepatology 1991;14(6):1029–34.

Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002;8(9):851–8.

Beaton MD, Adams PC. Treatment of hyperferritinemia. Ann Hepatol 2012;11(3):294–300.

Bugianesi E, Manzini P, D’Antico S, Vanni E, Longo F, Leone N, et al. Relative contribution of iron burden, HFE mutations, and insulin resistance to fibrosis in nonalcoholic fatty liver. Hepatology 2004;39(1):179–87.

Walker NM, Stuart KA, Ryan RJ, Desai S, Saab S, Nicol JA, et al. Serum ferritin concentration predicts mortality in patients awaiting liver transplantation. Hepatology 2010;51(5):1683–91.

Maiwall R, Kumar S, Chaudhary AK, Maras J, Wani Z, Kumar C, et al. Serum ferritin predicts early mortality in patients with decompensated cirrhosis. J Hepatology 2014;61(1):43–59.

Weismüller TJ, Kirchner GI, Scherer MN, Negm AA, Schnitzbauer AA, Lehner F, et al. Serum ferritin concentration and transferrin saturation before liver transplantation predict decreased long-term recipient survival. Hepatology 2011;54(6):2114–24.

Kowdley KV, Belt P, Wilson LA, Yeh MM, Neuschwander-Tetri BA, Chalasani N, et al. Elevated serum ferritin is an independent predictor of histologic severity and advanced fibrosis among patients with nonalcoholic fatty liver disease. Hepatology 2012;55(1);77–85.

Oikonomou T, Goulis I, Soulaidopoulos S, Karasmani A, Doumtsis P, Tsioni K, et al. High serum ferritin is associated with worse outcome of patients with decompensated cirrhosis. Ann Gastroenterol 2017;30(2):217–24.

Adams PC, Barton JC, Guo H, Alter D, Speechley M. Serum ferritin is a biomarker for liver mortality in the Hemochromatosis and Iron Overload Screening Study. Ann Hepatol 2015;14(3):348–53.

Bruns T, Nuraldeen R, Mai M, Stengel S, Zimmermann HW, Yagmur E, et al. Low serum transferrin correlates with acute-on-chronic organ failure and indicates short-term mortality in decompensated cirrhosis. Liver Int 2017;37(2):232–41.