# Hyperferritinemia Drives Risk: Unravelling the Association Between Ferritin Levels and Multi-Organ Dysfunction in Acute Febrile Illness: An Emergency Medicine Perspective

## TL;DR

High ferritin levels are linked to severe illness and death in patients with fevers and organ failure, especially in older individuals.

## Contribution

This study identifies serum ferritin as a novel prognostic marker for mortality and multi-organ dysfunction in acute febrile illness.

## Key findings

- Elevated serum ferritin levels were significantly associated with increased mortality in patients with acute febrile illness.
- Older patients and those with neurological symptoms or respiratory distress had higher mortality rates.
- Serum ferritin levels correlated with prolonged hospital stays and multi-organ dysfunction.

## Abstract

Background: Hyperferritinemia has been increasingly recognized as a marker of systemic inflammation, immune dysregulation, and multi-organ failure. This study examines the association between vital signs, laboratory parameters (including serum ferritin), and clinical outcomes (discharge and mortality) among patients presenting with acute febrile illness and multi-organ dysfunction in a tropical emergency department.

Aim: To determine the association between serum ferritin levels and multi-organ failure in patients with acute febrile illness.

Methods: The study was conducted in the emergency department of a tertiary-level institute. Patients with acute febrile illness and multi-organ dysfunction without a definitive diagnosis were enrolled. All participants underwent routine blood investigations (hemogram, liver, and renal function tests), tropical serology (dengue, leptospirosis, malaria, chikungunya, and scrub typhus), and measurement of inflammatory markers, including C-reactive protein and serum ferritin.

Results. A total of 72 patients were included; 44 (61.1%) were male, and 28 (38.9%) were female. Mortality was notably higher in patients over 50 years, especially those above 60. Fever was the predominant symptom in 69 (95.8%) patients, while 16 (22.2%) patients exhibited bleeding manifestations.

Key factors that were significantly associated with mortality included Glasgow Coma Scale (GCS) score (p = 0.002), blood urea (p = 0.001), serum creatinine (p = 0.004), serum ferritin (p = 0.034), serum bilirubin (p = 0.019), and serum glutamic-oxaloacetic transaminase (SGOT) levels (p = 0.048). These findings indicate that patients with severe organ dysfunction have a higher risk of mortality. The effectiveness of transfusions in modifying outcomes remains uncertain.

Conclusions: Mortality was highest among older patients and those with multiple organ involvement, neurological symptoms, respiratory distress, infections, or hemodynamic instability. Elevated serum ferritin levels were strongly correlated with increased mortality, multi-organ dysfunction, and prolonged hospital stays, reinforcing their prognostic value. Complications such as encephalitis, shock, myocarditis, and acute respiratory distress syndrome (ARDS) significantly increased mortality rates. Duration of hospitalization was also a critical determinant of survival.