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The role of hypoxia and inflammation in the regulation of iron metabolism and erythropoiesis in COVID-19: The IRONCOVID study.
Maira, Diletta; Duca, Lorena; Busti, Fabiana; Consonni, Dario; Salvatici, Michela; Vianello, Alice; Milani, Angelo; Guzzardella, Amedeo; Di Pierro, Elena; Aliberti, Stefano; Baldini, Itala Marina; Bandera, Alessandra; Blasi, Francesco; Cassinerio, Elena; Cesari, Matteo; Fracanzani, Anna Ludovica; Grasselli, Giacomo; Graziadei, Giovanna; Lombardi, Rosa; Marchi, Giacomo; Montano, Nicola; Monzani, Valter; Peyvandi, Flora; Proietti, Marco; Sandri, Maria; Valenti, Luca; Cappellini, Maria Domenica; Girelli, Domenico; Protti, Alessandro; Motta, Irene.
  • Maira D; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, General Medicine Unit, Milan, Italy.
  • Duca L; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, General Medicine Unit, Milan, Italy.
  • Busti F; Department of Medicine, Section of Internal Medicine, EuroBloodNet Center, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
  • Consonni D; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Epidemiology Unit, Milan, Italy.
  • Salvatici M; Bianalisi Laboratory, Carate Brianza, Italy.
  • Vianello A; Department of Medicine, Section of Internal Medicine, EuroBloodNet Center, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
  • Milani A; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy.
  • Guzzardella A; Department of Anesthesia and Intensive Care Units, IRCCS-Humanitas Research Hospital, Rozzano (Milan), Italy.
  • Di Pierro E; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Intensive Care and Emergency, Milan, Italy.
  • Aliberti S; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, General Medicine Unit, Milan, Italy.
  • Baldini IM; Respiratory Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy.
  • Bandera A; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, General Medicine Unit, Milan, Italy.
  • Blasi F; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy.
  • Cassinerio E; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Cesari M; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Fracanzani AL; Respiratory Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Grasselli G; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, General Medicine Unit, Milan, Italy.
  • Graziadei G; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.
  • Lombardi R; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
  • Marchi G; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Montano N; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine and Metabolic Disease Unit, Milan, Italy.
  • Monzani V; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Intensive Care and Emergency, Milan, Italy.
  • Peyvandi F; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Proietti M; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, General Medicine Unit, Milan, Italy.
  • Sandri M; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Valenti L; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine and Metabolic Disease Unit, Milan, Italy.
  • Cappellini MD; Department of Medicine, Section of Internal Medicine, EuroBloodNet Center, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
  • Girelli D; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
  • Protti A; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine, Immunology and Allergology Unit, Milan, Italy.
  • Motta I; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, High Care Internal Medicin Unit, Milan, Italy.
Am J Hematol ; 97(11): 1404-1412, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1976682
ABSTRACT
Coronavirus Disease (COVID-19) can be considered as a human pathological model of inflammation combined with hypoxia. In this setting, both erythropoiesis and iron metabolism appear to be profoundly affected by inflammatory and hypoxic stimuli, which act in the opposite direction on hepcidin regulation. The impact of low blood oxygen levels on erythropoiesis and iron metabolism in the context of human hypoxic disease (e.g., pneumonia) has not been fully elucidated. This multicentric observational study was aimed at investigating the prevalence of anemia, the alterations of iron homeostasis, and the relationship between inflammation, hypoxia, and erythropoietic parameters in a cohort of 481 COVID-19 patients admitted both to medical wards and intensive care units (ICU). Data were collected on admission and after 7 days of hospitalization. On admission, nearly half of the patients were anemic, displaying mild-to-moderate anemia. We found that hepcidin levels were increased during the whole period of observation. The patients with a higher burden of disease (i.e., those who needed intensive care treatment or had a more severe degree of hypoxia) showed lower hepcidin levels, despite having a more marked inflammatory pattern. Erythropoietin (EPO) levels were also lower in the ICU group on admission. After 7 days, EPO levels rose in the ICU group while they remained stable in the non-ICU group, reflecting that the initial hypoxic stimulus was stronger in the first group. These findings strengthen the hypothesis that, at least in the early phases, hypoxia-driven stimuli prevail over inflammation in the regulation of hepcidin and, finally, of erythropoiesis.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Erythropoietin / COVID-19 / Anemia Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Am J Hematol Year: 2022 Document Type: Article Affiliation country: Ajh.26679

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Erythropoietin / COVID-19 / Anemia Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Am J Hematol Year: 2022 Document Type: Article Affiliation country: Ajh.26679