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Hepcidin detects iron deficiency in Sri Lankan adolescents with a high burden of hemoglobinopathy: A diagnostic test accuracy study.

Wray, Katherine and Allen, Angela and Evans, Emma and Fisher, Chris and Premawardhena, Anuja and Perera, Lakshman and Rodrigo, Rexan and Goonathilaka, Gayan and Ramees, Lebbe and Webster, Craig and Armitage, Andrew E and Prentice, Andrew M and Weatherall, David J and Drakesmith, Hal and Pasricha, Sant-Rayn (2017) Hepcidin detects iron deficiency in Sri Lankan adolescents with a high burden of hemoglobinopathy: A diagnostic test accuracy study. American journal of hematology, 92 (2). pp. 196-203. ISSN 1096-8652. This article is available to all HEFT staff and students via ASK HEFT Discovery tool www.heftlibrary.nhs.uk using their HEFT Athens Login.

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Official URL: http://onlinelibrary.wiley.com/doi/10.1002/ajh.246...

Abstract

Anemia affects over 800 million women and children globally. Measurement of hepcidin as an index of iron status shows promise, but its diagnostic performance where hemoglobinopathies are prevalent is unclear. We evaluated the performance of hepcidin as a diagnostic test of iron deficiency in adolescents across Sri Lanka. We selected 2273 samples from a nationally representative cross-sectional study of 7526 secondary schoolchildren across Sri Lanka and analyzed associations between hepcidin and participant characteristics, iron indices, inflammatory markers, and hemoglobinopathy states. We evaluated the diagnostic accuracy of hepcidin as a test for iron deficiency with estimation of the AUC(ROC) , sensitivity/specificity at each hepcidin cutoff, and calculation of the Youden Index to find the optimal threshold. Hepcidin was associated with ferritin, sTfR, and hemoglobin. The AUC(ROC) for hepcidin as a test of iron deficiency was 0.78; hepcidin outperformed Hb and sTfR. The Youden index-predicted cutoff to detect iron deficiency (3.2 ng/mL) was similar to thresholds previously identified to predict iron utilization and identify deficiency in African populations. Neither age, sex, nor α- or β-thalassemia trait affected diagnostic properties of hepcidin. Hepcidin pre-screening would prevent most iron-replete thalassemia carriers from receiving iron whilst still ensuring most iron deficient children were supplemented. Our data indicate that the physiological relationship between hepcidin and iron status transcends specific populations. Measurement of hepcidin in individuals or populations could establish the need for iron interventions. Am. J. Hematol. 92:196-203, 2017. © 2016 Wiley Periodicals, Inc.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK HEFT Discovery tool www.heftlibrary.nhs.uk using their HEFT Athens Login.
Subjects: WH Haemic and lymphatic systems. Haematology
Divisions: Clinical Support > Pharmacy
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Depositing User: Mrs Yolande Brookes
Date Deposited: 10 Feb 2017 10:11
Last Modified: 10 Feb 2017 10:11
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1183

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