This report provides perspectives concerning dual roles of serum ferritin as a measure of both iron status and inflammation. We suggest benefits of a lower range of serum ferritin as has occurred for total serum cholesterol and fasting blood glucose levels. Observations during a prospective randomized study using phlebotomy in patients with peripheral arterial disease offered unique insights into dual roles of serum ferritin both as an iron status marker and acute phase reactant. Robust positive associations between serum ferritin, interleukin 6 [IL-6], tissue necrosis factor-alpha, and high sensitivity C-reactive protein were discovered. Elevated serum ferritin and IL-6 levels associated with increased mortality and with reduced mortality at ferritin levels <100 ng mL-1. Epidemiologic studies demonstrate similar outcomes. Extremely elevated ferritin and IL-6 levels also occur in individuals with high mortality due to SARS-CoV-2 infection. Disordered iron metabolism reflected by a high range of serum ferritin level signals disease severity and outcomes. Based upon experimental and epidemiologic data, we suggest testing the hypotheses that optimal ferritin levels for cardiovascular mortality reduction range from 20 to 100 ng mL-1 with % transferrin levels from 20 to 50%, to ensure adequate iron status and that ferritin levels above 194 ng mL-1 associate with all-cause mortality in population cohorts.

中文翻译：

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最佳血清铁蛋白水平范围：铁状态测量和炎症生物标志物。

本报告提供了关于血清铁蛋白作为铁状态和炎症指标的双重作用的观点。我们建议较低范围的血清铁蛋白有益，正如总血清胆固醇和空腹血糖水平所发生的那样。在外周动脉疾病患者中使用静脉切开术的前瞻性随机研究中的观察结果为血清铁蛋白作为铁状态标志物和急性期反应物的双重作用提供了独特的见解。发现血清铁蛋白、白细胞介素 6 [IL-6]、组织坏死因子-α 和高敏感性 C 反应蛋白之间存在强烈的正相关关系。血清铁蛋白和 IL-6 水平升高与死亡率增加相关，铁蛋白水平 <100 ng mL-1 时死亡率降低。流行病学研究证明了类似的结果。在因 SARS-CoV-2 感染而致死率高的个体中，也会出现铁蛋白和 IL-6 水平极高的情况。高范围的血清铁蛋白水平反映的铁代谢紊乱表明疾病的严重程度和结果。根据实验和流行病学数据，我们建议检验以下假设：降低心血管死亡率的最佳铁蛋白水平范围为 20 至 100 ng mL-1，转铁蛋白百分比水平为 20 至 50%，以确保充足的铁状态和铁蛋白水平高于 194 ng mL-1 与人群队列中的全因死亡率相关。