Anemia da doença crônica no idoso: avaliação da expressão da hepcidina e sua relação com citocinas pró-inflamatórias e parâmetros clínico-laboratoriais

Abstract

Anemia of chronic disease (ACD) or anemia of inflammation is common in the elderly and is associated with infectious, inflammatory, and neoplastic diseases. Its pathophysiology includes the action of inflammatory cytokines and the regulation of Hepcidin, which acts on iron metabolism and homeostasis. In this context, the study aimed to evaluate the expression of serum Hepcidin and the profile of inflammatory cytokines, INF- and IL-6, and to correlate with iron markers and with clinical and laboratory variables in elderly people with ACD. The study was carried out at the HUWC hematology outpatient clinic and included 90 elderly people diagnosed with ADC and, as a control group, 70 healthy elderly people. Clinical and demographic data were collected from medical records. Serum levels of Hepcidin, IL-6 and IFN-γ were determined by ELISA. It was identified that among the 90 patients, 22% were female and 78% male. The mean age was 74.12 ± 7.87. 17% smoked and 18% drank. Most patients had ≥ 3 comorbidities (70%), with SAH (90%), DM (58%) and dyslipidemia (40%) being the most common comorbidities. Women had lower Hb levels than men (10.2 g/Dl versus 11.1 g/dL, p=0.03) and patients > 80 years had lower Hb than those < 80 years (9, 36 g/dL versus 10.6, p<0.001). The presence of habits such as smoking and drinking did not influence the severity of anemia. Serum iron levels were significantly lower in patients than in controls (64.13 µg/dL versus 99.83 µg/dL, p<0.001), and STI (23.90% versus 33.47%, p< 0.001). Serum ferritin levels were significantly higher in patients than in controls. (219.21 ng/ml versus 75.47 ng/ml, p<0.001). Hepcidin dosage showed significantly higher levels in patients than in controls. (43.83 ng/mL versus 23.77 ng/mL, p<0.001) In patients with ≥ 3 comorbidities the Hepcidin level was significantly higher than in those with <3 comorbidities (48.6 ng/mL versus 32.65 ng/ml, p < 0.001). Hepcidin level showed a negative, moderate and significant correlation with low levels of hemoglobin (r=0.35; p<0.001) and high levels of ferritin (r=0.537; p<0.001). The IFN-γ dosage showed significantly higher values in patients than in controls (72.3 pg/ml versus 34.9 pg/ml, p<0.001) and in females than in males (p=0.004). The level of IFN-γ showed a negative, moderate and significant correlation with lower levels of hemoglobin (r=0.405, p<0.001) and higher levels of Hepcidin (r=0.228, p=0.004). The IL-6 dosage was significantly higher in patients than in controls (402 pg/ml versus 97.3 pg/ml, p<0.001) and showed no significant correlation with IFN-γ and Hepcidin levels. It is concluded that female sex, age > 80 years and presence of multiple comorbidities were associated with lower hemoglobin levels, dysregulation in iron metabolism and increased Hepcidin and IFN-γ in elderly patients with ACD. These findings highlight the association of Hepcidin and IFN-γ in the pathophysiology and its recognition as a potential target for diagnostic approaches in ACD.