Significance of hyperferritinemia as a diagnostic and prognostic biomarker

Ferritin is a complex protein composite (iron protein) that plays the role of the main intracellular iron depot in humans and animals, consisting of the protein apoferritin and the ferric atom in the composition of phosphate hydroxide. The reference value of ferritin in women is 200 fig/l, in men — 300fig/l. Ferritin is a marker of total body iron stores, and low levels are specific for iron deficiency. Ferritin is also involved in immune processes and has both pro-inflammatory and immunosuppressive activity. Hyperferritinemia is a nonspecific symptom that occurs in a number of immunoinflammatory, infectious diseases, as well as during body iron stores overload. Hyperferritinemia is a criterion sign of macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis, systemic lupus erythematosus and Kawasaki disease, as well as a predictive biomarker of adult-onset Still's disease. High ferritin levels occur in catastrophic antiphospholipid syndrome, as well as in infectious pathologies such as septic shock and COVID-19, including multisystem inflammatory syndrome associated with COVID-19. Ferritin concentration is an important parameter for assessing the activity and prognosis of the disease, which allows a rational approach to the choice of therapy in these patients. © 2022, Ima-Press Publishing House. All rights reserved.

Coronavirus Desease 2019 (COVID-19) in Children: Lessons from Pediatric Rheumatology

The clinical presentation and outcomes of infection with the novel coronavirus (COVID-19) are characterized by exceptional variability in manifestations, which depend on many factors, one of which is the patient’s age. One of the severe life-threatening manifestations in adults is severe acute respiratory syndrome (SARS-CoV-2), in some cases accompanied by the development of multiple organ failure. During the first two to three months of the COVID-19 pandemic, the global medical community was of the opinion that this disease in children is usually mild and not fatal. However, with the accumulation of new information, it became clear that there is a growing recognition of the existence of multisystem inflammatory syndrome in children, chronologically associated with SARS-CoV-2, which can lead to serious consequences. The article presents the main epidemiological, clinical and laboratory characteristics of the syndrome, as well as discusses the issues of its pathogenesis, differential diagnosis with a number of other acute conditions associated with an dysbalance of cytokines. Клиническая картина и исходы коронавирусной болезни 2019 (coronavirus disease - COVID-19) зависят от многих факторов, одним из которых является возраст пациента. Одним из тяжелых жизнеугрожающих проявлений у взрослых является острый респираторный дистресс-синдром (ОРДС), в ряде случаев сопровождающийся развитием полиорганной недостаточности. В течение первых месяцев пандемии COVID-19 сложилось мнение, что у детей это заболевание, как правило, протекает в легкой форме и не приводит к летальному исходу. Однако по мере накопления новых сведений стала очевидной возможность тяжелого течения COVID-19 у детей, приводящего к развитию патологии, получившей название «мультисистемный воспалительный синдром» (Multisystem inflammatory syndrome in children - MIS-C). В статье обсуждаются эпидемиологические, клинические и лабораторные характеристики MIS-C, подходы к дифференциальной диагностике с другими воспалительными заболеваниями у детей, предполагаемые механизмы иммунопатогенеза и перспективы фармакотерапии.