Unraveling the differential diagnosis of hyperferritinemia: insights from a retrospective study at a tertiary care hospital

Abstract

Objectives: Elevated serum ferritin levels are associated with various clinical conditions, including inflammation and tissue damage. This study aims to investigate the distribution of diagnoses associated with hyperferritinemia in different clinical contexts. Methods: Patients admitted to Severance Hospital, Seoul, Korea, between January and December 2017, with serum ferritin levels of 500 ng/ml or higher, were included. A retrospective chart review was conducted to collect demographic information, underlying diseases, ferritin levels, and febrile status. Patients were categorized by age (>= 20 vs. <20 years), febrile status (febrile vs. afebrile), and ferritin cut-off levels (>= 500, >= 1000, >= 2000, >= 3000, and >= 10000 ng/ml). Diagnoses were classified into 10 categories, and their distribution was analyzed across patient subgroups with different characteristics. Results: Among 2044 patients with hyperferritinemia, solid organ malignancies (37.1%) were the most common cause, followed by infections (23.4%) and hematologic disorders (14.9%). Younger patients had higher ferritin levels and a greater prevalence of hematologic (38.8% vs. 12.9%) and rheumatic diseases (6.6% vs. 3.7%). Febrile patients exhibited higher ferritin levels and more frequent diagnoses of infections (27.2% vs. 12.5%), hematologic (16.2% vs. 11.2%), and rheumatic diseases (4.7% vs. 1.5%). As ferritin levels increased, hematologic and rheumatic diseases became more prevalent, although other diagnoses remained common across ferritin levels. Conclusion: Hyperferritinemia has a broad range of underlying causes, with diagnostic distributions varying by age, febrile status, and ferritin levels. These findings underscore the importance of comprehensive evaluation and contextual interpretation for patients with unexplained hyperferritinemia, advocating for a tailored diagnostic approach based on clinical context.