Using Iron-Chelating Agents in Critically Ill Patients with Iron Overload. Fact or Fiction?

Recently, some evidence has shown that the failure of iron homeostasis may occur in critically ill patients and can lead to iron overload (1, 2). Elevated ferritin levels as a body iron burden index in critically ill patients may be associated with depressed level of consciousness and greater mortality (3, 4). However, the necessity of using ironchelating agents in clinical situation is still unknown for these cases. Oxidative stress, inflammation and increased iron stores are concepts related to each other. Oxidative stress has been defined by an imbalance between prooxidant and antioxidant conditions, which along with boosted inflammatory response have been commonly reported in critical situation in patients admitted to the intensive care unit (ICU) (5, 6). Inflammation and oxidative stress can also be considered as one of the most important probable causes of increased iron stores in critical patients (7). Likewise, iron excess promotes the generation of reactive oxygen species (ROS) and oxidative stress via Fenton reaction , as well as the increase of susceptibility to infection (2). It should be mentioned that the relationship between iron overload and infectious diseases has been relatively proved (7). Imbalance iron metabolism and iron overload status can be deteriorated after emerging infection in these patients.