Iron Dysregulation During Severe COVID-19: Longitudinal Evidence from Hospitalized Patients
5 affiliations
- 1Section of Internal Medicine, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata di Verona, 37134 Verona, Italy
- 2Urgency Medicine Unit, Department of Medicine, University of Verona, 37134 Verona, Italy
- 3Unit of Internal Medicine, Department of Medicine, University of Verona, 37134 Verona, Italy
- 4Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
- 5Section of Clinical Biochemistry, Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy
Abstract
Background/Objectives: The COVID-19 pandemic underlined the critical role of iron homeostasis in infections, particularly in those cases where hyperinflammation, fueled by massive elevation in cytokines such as IL-6, TNF-α, and IL-8, triggered acute respiratory distress syndrome (ARDS), progressive multiorgan failure and heightened mortality. This extreme immune response aggravates systemic iron imbalance and eventually triggers a vicious cycle in which the inflammatory state fuels the impaired iron metabolism, thereby contributing to disease severity. The main goal of this work was to disentangle the relationships between inflammation and iron metabolism in a cohort of well-characterized patients hospitalized for severe COVID-19. Methods: This study evaluated 389 patients hospitalized with COVID-19 pneumonia in a medical ward at Verona University Hospital. Complete clinical parameters, inflammatory, and iron-related markers’ trends were analyzed over time during hospitalization (admission (T0), 1 week (T1), and 2 weeks after (T2)). Subjects were grouped by disease severity during hospitalization. Results: High-severity cases showed significantly higher concentrations of IL-8, IL-6, IL-10, hepcidin, and ferritin at baseline. Hepcidin correlated strongly with inflammatory markers and was a predictor of COVID-19 severity (p = 0.014). Despite a gradual decrease, hepcidin levels remained significantly higher in patients with a more serious form of the disease across time points. Conclusions: Our findings underscore the clinical utility of iron-related markers in COVID-19 management and the relevance of their assessment in clinical settings for better patient stratification.
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BibTeX
@article{antinori2026iron,
title = {{Iron Dysregulation During Severe COVID-19: Longitudinal Evidence from Hospitalized Patients}},
author = {Elisa Antinori and Alice Vianello and Lorenzo Bertolone and Camila Dos Santos Lima and Fabiana Busti and Misha Fatima and Acaynne Lira Zidanes and Patrizia Pattini and Rossella Gottardo and Elisa Danese and Fabio Chesini and Simonetta Friso and Domenico Girelli and Annalisa Castagna},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18213570},
url = {https://www.mdpi.com/2072-6643/18/21/3570},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Iron Dysregulation During Severe COVID-19: Longitudinal Evidence from Hospitalized Patients
AU - Elisa Antinori
AU - Alice Vianello
AU - Lorenzo Bertolone
AU - Camila Dos Santos Lima
AU - Fabiana Busti
AU - Misha Fatima
AU - Acaynne Lira Zidanes
AU - Patrizia Pattini
AU - Rossella Gottardo
AU - Elisa Danese
AU - Fabio Chesini
AU - Simonetta Friso
AU - Domenico Girelli
AU - Annalisa Castagna
PY - 2026
DA - 2026/10/29
JO - Nutrients
DO - 10.3390/nu18213570
UR - https://www.mdpi.com/2072-6643/18/21/3570
AB - Background/Objectives: The COVID-19 pandemic underlined the critical role of iron homeostasis in infections, particularly in those cases where hyperinflammation, fueled by massive elevation in cytokines such as IL-6, TNF-α, and IL-8, triggered acute respiratory distress syndrome (ARDS), progressive multiorgan failure and heightened mortality. This extreme immune response aggravates systemic iron imbalance and eventually triggers a vicious cycle in which the inflammatory state fuels the impaired iron metabolism, thereby contributing to disease severity. The main goal of this work was to disentangle the relationships between inflammation and iron metabolism in a cohort of well-characterized patients hospitalized for severe COVID-19. Methods: This study evaluated 389 patients hospitalized with COVID-19 pneumonia in a medical ward at Verona University Hospital. Complete clinical parameters, inflammatory, and iron-related markers’ trends were analyzed over time during hospitalization (admission (T0), 1 week (T1), and 2 weeks after (T2)). Subjects were grouped by disease severity during hospitalization. Results: High-severity cases showed significantly higher concentrations of IL-8, IL-6, IL-10, hepcidin, and ferritin at baseline. Hepcidin correlated strongly with inflammatory markers and was a predictor of COVID-19 severity (p = 0.014). Despite a gradual decrease, hepcidin levels remained significantly higher in patients with a more serious form of the disease across time points. Conclusions: Our findings underscore the clinical utility of iron-related markers in COVID-19 management and the relevance of their assessment in clinical settings for better patient stratification.
SN - 2072-6643
ER -