Ability of serum ferritin to diagnose iron deficiency anemia in an elderly cohort

Abstract Background Diagnosis and treatment of iron deficiency anemia in older subjects improves their quality of life. Serum ferritin as a marker of iron stores is an acute phase protein. In older subjects who usually have many concomitant chronic medical conditions, serum ferritin may increase in response to inflammatory processes irrespective of iron stores. This study was performed to determine the diagnostic properties of serum ferritin in the diagnosis of iron deficiency anemia in older subjects. Methods This case-control study included all the inhabitants of Amirkola town who participated in the Amirkola Health and Aging Project. Diagnosis of anemia was confirmed based on a hemoglobin level <13 g/dL in men and <12 g/dL in women and iron deficiency anemia by percent transferrin saturation <15%. A receiver operating characteristic curve was constructed to determine an optimal serum ferritin cutoff value to differentiate patients with and without iron deficiency anemia at the highest sensitivity and specificity. Results Eighty patients with iron deficiency anemia and 160 cases of anemia without iron deficiency (mean age: 72.9 ± 8 and 71.6 ± 7.6 years, respectively; p-value = 0.37) were analyzed. In iron deficiency anemia, the mean serum ferritin was significantly lower (p-value = 0.036) compared to patients without iron deficiency anemia. Serum ferritin with a cutoff level of 100 ng/mL differentiated patients with and without iron deficiency anemia with a sensitivity of 60% and specificity of 59% and area under the receiver operating characteristic curve of 0.615 ± 0.040 (95% confidence interval: 0.536-0.694; p-value = 0.004). Conclusion These findings indicate that in elderly subjects, iron deficiency anemia may develop with higher levels of serum ferritin. Hence, the conventional cutoff of serum ferritin for the diagnosis of iron deficiency anemia in young adults is not appropriate for the elderly population.

Vitamin D Deficiency is Associated with Nonspecific Low Back Pain in Young Women, a Case-Control Study.

Background: Vitamin D deficiency is linked to several musculoskeletal conditions including nonspecific low back pain, autoimmune diseases. Data regarding to vitamin D deficiency and low back pain are not consistent across various studies. The objective of this case-control study was to determine association of vitamin D deficiency and lowback pain in women. Methods: Eighty-one women with nonspecific low back pain and 101 age-matched controls entered the study. Serum vitamin D was assessed by quantitative determination of serum 25-hydroxyvitamin D (25-OHD) by electerochemiluminecence method, and levels <20ng/ml were considered as vitamin D deficiency. Mann-Whitney U test and chi square test was used for analysis. Results: Mean age of patients and controls was 35.1±8.14 and 37.4±7.9 years respectively. Median serum 25-OHD concentration in patients was significantly lower than control group (p=0.003). Serum 25-OHD deficiency was observed in 57(70.4%) patients versus 47(46.5%) controls (p=0.001). There was a significant association between serum 25-OHD deficiency and low back pain (OR=2.72, 95%CI, 1.47-5, p=0.001). 25-OHD deficiency was significantly correlated with low back pain (r=0.239, p=0.001). Conclusion: This study indicates a significant association between vitamin D deficiency and nonspecific LBP in women and justifies serum 25-OHD assessment in women with low back pain.

Efficiency of Supplemental Vitamin D in Patients with Chronic Obstructive Pulmonary Disease.

Aims: To investigate the impact of supplemental vitamin D on pulmonary function in patients with stable chronic obstructive pulmonary disease (COPD). Study Design: Case-control study Place and Duration of Study: Department internal medicine, Rouhani hospital, Babol university of medical sciences, Babol, Iran. Over six months from September 2011 through February 2012 Methodology: Patients with COPD allocated to the treatment or control group intermittently. Thirty patients in the treatment group received 50.000 IU oral cholecalciferol weekly for two months plus routine treatment and 28 patients who served as controls received only their usual medications. The serum 25-hydroxyvitamin D (25-OHD) and FEV1% was measured at baseline and two months later. The primary objective was to determine treatment response defined as 5% or greater increase from baseline in FEV1% and the secondary objective was to determine the association between vitamin D supplementation and treatment response. In statistical analysis Spearman's correlation coefficient was used to determine correlation and logistic regression analysis with calculation of odds ratio (OR) was used to determine association. Results: Mean age of the patients and controls was 67.1±10.5 years and 66.±12.2 years respectively (P=0.83).Thirteen patients (43.3%) versus 3 (10.7%) controls responded to treatment (P=0.009). Treatment response was positively correlated with mean serum 25- OHD changes from baseline (Spearman's correlation coefficient = 0.358, P=0.026). Mean 25-OHD change from baseline in the responders was significantly higher than in no responders (P = 0.031). Mean 25-OHD changes were positively correlated with FEV1% (P = 0.013).Vitamin D supplementation increased the treatment response by OR = 6.37 (95% CI, 1.57-25.8). After adjustment for inhaled bronchodilator, corticosteroid therapy, age, weight, smoking, ESR and CRP the odds of treatment response in vitamin D group increased to 17.1 (95%CI, 2.39-122, P= 0.005). Conclusion: The findings of this study indicate that, two months vitamin D supplement to the drug regimen of COPD confers small pulmonary function improvement as compared with controls and justify serum 25-OHD measurement in COPD. Raising serum 25-OHD to sufficient levels with longer duration of treatment may exert further benefits.