Iron metabolism biomarkers—specifically ferritin, transferrin, and TIBC—serve as independent predictors of 28-day mortality risk in patients with acute coronary syndrome, and a risk prediction model integrating these markers demonstrated superior discriminative performance (AUC: 0.69–0.75) compared to conventional scoring systems.
Elevated ferritin was independently associated with higher 28-day mortality risk in ACS patients.
Higher transferrin levels were independently associated with a protective effect against 28-day mortality in ACS patients.
Higher total iron-binding capacity (TIBC) was independently associated with a protective effect against 28-day mortality in ACS patients.
Serum iron showed no significant association with short-term 28-day mortality in ACS patients.
A multivariate logistic regression risk prediction model integrating iron biomarkers with eight other independent predictors outperformed traditional critical illness scoring systems.
The study cohorts showed notably different 28-day mortality rates between the two databases.
Quartile-based analysis of iron biomarkers revealed clinically meaningful risk gradients for 28-day mortality in ACS patients.
This research suggests that certain iron-related blood markers can predict short-term survival odds for patients admitted to intensive care with severe heart attacks (acute coronary syndrome). Specifically, researchers analyzed data from over 2,300 such patients across two large clinical databases (MIMIC and eICU) and found that higher levels of ferritin—a protein that stores iron—were linked to a roughly doubled risk of dying within 28 days, while higher levels of transferrin and total iron-binding capacity (TIBC), which reflect the body's ability to transport iron, were associated with substantially lower death risk. Notably, serum iron itself—the simplest measure of iron in the blood—was not meaningfully linked to survival outcomes. The researchers also built a risk prediction model combining these iron markers with eight other patient characteristics, and this model performed better than standard ICU severity scoring tools at identifying which patients were at highest risk of dying, with accuracy scores (AUC) ranging from 0.69 to 0.75 across different patient groups. These findings held up when tested in an entirely separate patient database, lending confidence to their reliability. This research suggests that routinely measuring iron metabolism markers—particularly ferritin, transferrin, and TIBC—in heart attack patients could help doctors identify those at greatest risk early on, potentially enabling more aggressive monitoring or treatment. The findings also open the door for future studies to explore whether interventions targeting iron metabolism might improve survival in this high-risk population.
Zha C, Yu Y, Zhu L, Zhang J, Diao Y, Wu Z. (2026). Exploring the relationship between iron metabolism biomarkers and 28 day prognosis in patients with severe acute coronary syndrome: a multicenter retrospective cohort study.. Scientific reports. https://doi.org/10.1038/s41598-026-49428-9