Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis

Karanvir Kaushal, Hardeep Kaur, Phulen Sarma, Anusuya Bhattacharyya, Dibya Jyoti Sharma, Manisha Prajapat, Mona Pathak, Ashish Kothari, Subodh Kumar, Satyavati Rana, Manpreet Kaur, Ajay Prakash, Anissa Atif Mirza, Prasan Kumar Panda, S. Vivekanandan, Balram Ji Omar, Bikash Medhi, Manisha Naithani

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Ferritin is a known inflammatory biomarker in COVID-19. However, many factors and co-morbidities can confound the level of serum ferritin. This current metaanalysis evaluates serum ferritin level in different severity levels in COVID-19. Studies evaluating serum ferritin level in different clinical contexts (COVID-19 vs. control, mild to moderate vs. severe to critical, non-survivor vs. survivor, organ involvement, ICU and mechanical ventilation requirement) were included (total 9 literature databases searched). Metaanalysis and metaregression was carried out using metaphor “R” package. Compared to control (COVID-19 negative), higher ferritin levels were found among the COVID-19 patients [SMD −0.889 (95% C.I. −1.201, −0.577), I2 = 85%]. Severe to critical COVID-19 patients showed higher ferritin levels compared to mild to moderate COVID-19 patients [SMD 0.882 (0.738, 1.026), I2 = 85%]. In meta-regression, high heterogeneity was observed could be attributed to difference in “mean age”, and “percentage of population with concomitant co-morbidities”. Non-survivors had higher serum ferritin level compared to survivors [SMD 0.992 (0.672, 1.172), I2 = 92.33%]. In meta-regression, high heterogeneity observed could be attributed to difference in “mean age” and “percentage of male sex”. Patients requiring ICU [SMD 0.674 (0.515 to 0.833), I2 = 80%] and mechanical ventilation [SMD 0.430 (0.258, 0.602), I2 = 32%] had higher serum ferritin levels compared to those who didn't. To conclude, serum ferritin level may serve as an important biomarker which can aid in COVID-19 management. However, presence of other co-morbid conditions/confounders warrants cautious interpretation.

Original languageEnglish
Pages (from-to)172-181
Number of pages10
JournalJournal of Critical Care
StatePublished - Feb 2022


  • Biomarker
  • COVID-19
  • Diagnosis
  • Ferritin
  • Hyperferritin
  • Prognosis
  • SARS-CoV2


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