Lachmann et al reviewed causes of hyperferritinemia that may be encountered in the intensive care unit (ICU). The authors are from multiple institutions in German.
Patient selection: adult (age >= 18 years) in ICU with hyperferritinemia
The maximum serum ferritin concentration in the study was over 100,000 µg/L (upper limit of normal 500).
Conditions with the highest serum ferritin concentrations:
(1) hemophagocytic lymphohistiocytosis
(2) sepsis or septic shock
Infectious causes other than sepsis:
(1) Varicella-Zoster virus infection
(2) viral hepatitis
(3) malaria
(4) Herpes simplex virus (HSV)
(5) influenza
(6) cytomegalovirus (CMV)
(7) HIV
(8) tuberculosis
(9) Epstein-Barr virus (EBV)
(10) other infection
Malignant causes:
(1) solid malignancy
(2) hematologic malignancy
Miscellaneous causes
(1) autoimmune disease
(2) other causes of systemic inflammation
(3) acute or chronic renal disease
(4) acute or chronic liver disease
(5) stem cell or organ transplant
Risk factors for in-hospital mortality:
(1) advanced age
(2) higher serum ferritin
(3) higher SOFA score
(4) sepsis or septic shock
