The Role of Ferritin and Carboxyhemoglobin as Inflammatory Biomarkers in Sepsis and Septic Shock

Abstract

Background: While increased carbon monoxide production in sepsis is well-documented, the role of carboxyhemoglobin blood level fluctuations as a potential indicator of disease progression in sepsis remains unclear.

Objective: This study evaluates carboxyhemoglobin as a biomarker in sepsis and septic shock, comparing it with ferritin, C-reactive protein, and procalcitonin while assessing its potential as a bedside indicator for disease severity and mortality.

Material and Methods: We conducted a pilot, prospective, and observational study involving 52 patients diagnosed with sepsis or septic shock based on the SEPSIS 3 Consensus criteria. Clinical and laboratory parameters were monitored on days 1 and 5 following inclusion in the study.

Results: We observed a statistically significant variation in C-reactive protein and the severity scores for the sepsis and septic shock groups, and in carboxyhemoglobin, procalcitonin and one severity score for the survivor and non-survivor groups. In the survivor group we observed a statistically significant correlation between ferritin and the C-reactive protein, while for non-survivors, ferritin correlated with the APACHE II severity score. For all the studied groups we observed a statistically significant correlation between both studied severity scores.

Conclusions: Carboxyhemoglobin shows potential as a biomarker for monitoring sepsis progression, with its trends offering more clinical value than absolute cutoff values. Ferritin remains a dependable marker of inflammation and, when analyzed alongside carboxyhemoglobin and other known inflammatory biomarkers, provides a comprehensive view of sepsis progression, aiding in effective management.