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Serum Hepcidin and Ferritin to Iron Ratio in Evaluation of Bacterial Versus Viral Infections in Children: A Single-center Study

Kossiva, Lydia MD, PhD*; Gourgiotis, Dimitrios I. PhD; Tsentidis, Charalampos MD*; Anastasiou, Theodora MD, PhD; Marmarinos, Antonis MSc; Vasilenko, Helen MD*; Sdogou, Triantafyllia MD*; Georgouli, Helen MD, PhD*

The Pediatric Infectious Disease Journal: August 2012 - Volume 31 - Issue 8 - p 795–798
doi: 10.1097/INF.0b013e318256f843
Original Studies

Background: Differential diagnosis of childhood infections is important. Several biochemical indices steer diagnosis toward bacterial agents, although the data are often not definitive. Hepcidin is a central component of blood iron, and ferritin alterations occur during infections. We measured hepcidin changes and evaluated ferritin to iron ratio (FIR) in patients with suspected infections.

Methods: We studied 69 children with infection and an equal number of matched controls during a 3-year period. A bacterial agent was demonstrated in 17 and a viral pathogen in 52 of the patients. Hematologic and biochemical tests were performed on all children including ferritin, iron and hepcidin. FIR was calculated and receiver operating characteristic curve analysis was performed to evaluate the best FIR cutoff value to discriminate between patients and controls and between patients with bacterial infections and viral infections.

Results: Hepcidin, ferritin and FIR were significantly higher and iron values significantly lower in febrile patients than its controls. Patients with bacterial infection had significantly lower iron and higher FIR than those with viral infection. FIR had high accuracy discriminating patients from controls but only moderate accuracy discriminating bacterial from viral infected patients.

Conclusions: If further studies with larger samples confirm these observations, FIR could be used as an inexpensive, rapid and easily performed complementary index for diagnosis of bacterial infections.

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From the *Second Department of Pediatrics, ‘P&A Kyriakou’ Children’s Hospital, Medical School, Athens, Greece; Laboratory of Clinical Biochemistry-Molecular Diagnostics, Second Department of Pediatrics, ‘P&A Kyriakou’ Children’s Hospital, Medical School, Athens, Greece; and Laboratory of Hematology, ‘P&A Kyriakou’ Children’s Hospital, Medical School, Athens, Greece.

Accepted for publication March 15, 2012.

The authors have no funding or conflicts of interest to disclose.

Address for Correspondence: Lydia Kossiva, MD, PhD, Second Department of Pediatrics, ‘P&A Kyriakou’ Children’s Hospital, Thevon & Levadias street, 11527, Athens, Greece. E-mail:

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© 2012 Lippincott Williams & Wilkins, Inc.