Iron metabolism and sepsis-associated liver injury: Methodological considerations and clinical perspectives

Abstract

This letter offered commentary on the recently published article by Wang et al that investigated the relationship between iron metabolism disorders and sepsis-associated liver injury (SALI). The original study identified serum iron and total iron-binding capacity as potential predictive markers of SALI, contributing important insights to critical care hepatology. In this correspondence several methodological considerations that may influence the interpretation and generalizability of the findings were discussed. These include the limitations of a single-center design, the lack of serial biomarker measurements, the omission of hepcidin (a central iron regulatory hormone) as a measured variable, and the exclusive reliance on biochemical criteria for diagnosing liver injury. The potential value of incorporating imaging modalities and additional iron-related markers such as ferritin and transferrin saturation were also highlighted. The aim was to reinforce the importance of a comprehensive approach to iron metabolism in sepsis and to suggest future directions for clinical research that may enhance the diagnostic and prognostic utility of iron-related biomarkers in SALI.

Keywords: Sepsis-associated liver injury; Iron metabolism; Hepcidin; Serum iron; Total iron-binding capacity; Prognostic markers; Biomarkers in critical illness; Liver imaging; Ferritin; Transferrin saturation

Core Tip: This letter to the editor provided commentary on a recent study addressing the relationship between iron metabolism and sepsis-associated liver injury. Key methodological considerations, including the absence of hepcidin (a central iron-regulating hormone) in the biomarker panel, and the reliance solely on biochemical criteria for sepsis-associated liver injury diagnosis were highlighted. The importance of serial measurements and imaging-based confirmation was emphasized. The discussion aimed to enhance clinical interpretation and guide future studies on the prognostic role of iron-related markers in critical care settings.