Relationship of Ferritin and Procalcitonin with SOFA-2 Scores in Intensive Care Patients with COVID-19-Associated Sepsis: A Cross-Sectional Analysis.

Background/

Objectives

We investigated the association of serum ferritin and procalcitonin (PCT) with Sepsis-related Organ Failure Assessment (SOFA)-2 score-based organ dysfunction severity in intensive care patients with COVID-19-associated sepsis.

Methods

Patients were stratified by day 5 ferritin (ng/mL) and PCT (μg/L) levels; associations were analysed across severity groups defined by an SOFA-2 score of <5 (mild) or ≥5 (severe).

Results

Day 5 PCT did not predict the SOFA-2 score (p > 0.05). The optimal day 5 ferritin cut-off was >1191 ng/mL (35.78% sensitivity, 82.38% specificity; area under the curve (AUC) = 0.608). Day 5 ferritin was associated with SOFA-2 severity in the univariable analysis but did not remain an independent correlate after adjustment for C-reactive protein (CRP) and lactate dehydrogenase (LDH); in a mortality model, neither ferritin nor PCT independently predicted intensive care unit (ICU) death. PCT provided no predictive value beyond existing inflammatory markers, consistent with its suppression during viral infections.

Conclusions

Day 5 ferritin reflects, rather than independently predicts, organ dysfunction severity and may complement, rather than replace, established multi-parameter scoring. Relative to the independent determinants of severity and mortality (PaO2/FiO2 ratio, LDH, CRP, and age), day 5 ferritin is a specific, rule-in adjunctive marker of concurrent organ dysfunction rather than a standalone prognostic tool. Whether these associations extend to non-COVID sepsis populations requires prospective study.