Examining the results of the present study showed that there is a significant relationship between ferritin level and the incidence of cardiovascular disorders (P < 0.05). After the occurrence of Covid-19-19 disease in people, the possibility of acquired cardiovascular problems increases, which is consistent with the results of our study. So that covid-19 patients show the ferritin level as a factor in predicting the complications of the disease and the occurrence of heart failure in children.
Age and gender were effective on the relationship between ferritin and the occurrence of acquired cardiovascular disorders, and a significant relationship was seen in our results (P < 0.05). Compared to other groups, the highest rate of infection is seen in females and ages less than 6 months(17). Ahmed showed that ferritin has a significant relationship with the occurrence of complications and heart problems in Covid-19 patients, which is more evident with young age and in females(18). There is no significant relationship between Z Score, weight and the risk of acquired cardiovascular disorders in patients with Covid-19, while according to the results of Reyes study, people with Covid-19 with high serum ferritin in the follow-up show a high risk of CHD(19). Our results also clearly showed that children with higher weight had a lower chance of developing heart failure. Additionally, ferritin is as an inflammatory marker for predicting the severity and occurrence of disease complications such as heart disorders, which has a derivative relationship with age and gender(20).
Ferritin, the major intracellular iron storage protein, is an acute-phase reactant that is elevated in many inflammatory conditions, including acute infections, hyperferritinemic syndrome, a general term for macrophage activation syndrome, antiphospholipid syndrome, and septic shock(21, 22). Recent studies magnify ferritin as a predictor of ischemic heart disease mortality(23, 24), Liu states that there is an association between iron biomarkers and HF and cardiac ischemia, although they were strongly associated with CHD(25). Our results show similar propositions too, we were clearly show that cardiac disorders were correlated with ferritin level, and we should not forget the role of ferritin in other mechanisms of heart cells.
Higher levels of ferritin, along with other inflammatory markers, including CRP and IL-6, are associated with worse outcomes and may even help predict these coplications of Covid-19(26, 27). High ferritin activity is associated with aortic valve calcification, which It is associated with inflammatory factors such as TNF-α(28). Additionally, this element concentrations in COVID-19 patients, hyperferritinemia (ferritin level greater than 400 ng/ml) is associated with disease severity in patients(29). In the etiology of acquired cardiac complications caused by Covid-19 in patients, various factors have been proposed: including direct cardiotoxicity, systemic inflammatory response, imbalance between myocardial supply and demand, systemic thromboembolism, side effects of prescribed drugs, disseminated intravascular coagulation (DIC) and electrolyte disturbance(30–33). As the COVID-19 progresses and worsens, the probability of each of these mechanisms of heart damage also increases. Therefore, critically ill patients are at high risk of cardiac complications.
Eventually, the ferritin level has a high value for the prognosis of heart disorders in Covid-19 pediatric patients. The increase of ferritin is related to the child's weight and shows a higher sensitivity for heart diseases in children under one year of age. Our results showed that serum ferritin level is a predictive factor for acquired cardiovascular disorders, although, it cannot reliably predict the severity.