Towards a Common Definition for the Diagnosis of Iron Deficiency in Chronic Inflammatory Diseases

Iron deficiency (ID) in patients with chronic inflammatory diseases is frequent. However, under-diagnosis is also frequent due to the heterogeneity between guidelines from different medical societies. We applied a common definition for the diagnosis of ID to a large panel of patients with cancer, heart failure (HF), inflammatory bowel disease (IBD), and chronic kidney disease (CKD), where ID was defined as serum ferritin concentration <100 mu g/L and/or a transferrin saturation (TSAT) index <20%. Prevalence estimates using this common definition were compared with that obtained with officially accepted definitions (ESMO 2018, ESC 2016, ECCO 2015, and ERBP 2013). For that purpose, we used data collected during the French CARENFER studies, which included 1232, 1733, 1090, and 1245 patients with cancer, HF, IBD, and CKD, respectively. When applying the common definition, ID prevalence increased to 58.1% (vs. 57.9%), 62.8% (49.6%), and 61.2% (23.7%) in cancer, HF, and IBD patients, respectively. Both prevalence estimates were similar (47.1%) in CKD patients. Based on our results, we recommend combining both ferritin concentration and TSAT index to define ID in patients with chronic inflammatory diseases. In those patients, adopting this common definition of ID should contribute to a better screening for ID, whatever the condition.

Automated summary

Iron deficiency is common in patients with chronic inflammatory diseases, but under-diagnosis is frequent due to heterogeneity in medical society guidelines. This study found that applying a common definition for iron deficiency improved diagnosis rates in patients with cancer, heart failure, and inflammatory bowel disease.