Diagnostic Accuracy and Therapeutic Implications of Serum Hepcidin-25 and Ferritin in Anaemia of Chronic Disease: A Systematic Review and Meta- Analysis
Onia Orinate Peters
ABSTRACT
Background: Anaemia of Chronic Disease (ACD) is a prevalent condition in inflammatory states such as chronic kidney disease, rheumatoid arthritis, and inflammatory bowel disease, yet diagnostic ambiguity persists due to the confounding effects of inflammation on traditional biomarkers like ferritin.
Objective: This systematic review and meta-analysis evaluated the diagnostic accuracy and therapeutic implications of serum hepcidin-25 compared to ferritin in ACD.
Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, Web of Science, and Google Scholar (March 2000–March 2026) identified 1,847 records. After screening, 14 studies encompassing 2,847 patients were included. Pooled diagnostic accuracy metrics, correlation analyses, and effect estimates were calculated using random-effects models.
Results: Hepcidin-25 demonstrated superior diagnostic accuracy (AUROC 0.91, sensitivity 88%, specificity 85%) compared to ferritin (AUROC 0.78, sensitivity 75%, specificity 68%). Combined biomarker models achieved outstanding performance (AUROC 0.94). Hepcidin levels correlated significantly with disease severity (CKD: r=0.68; RA: r=0.62; IBD: r=0.59). Baseline hepcidin predicted therapeutic outcomes: low hepcidin associated with 78% ESA response rate (HR 2.4), while high hepcidin predicted oral iron failure (30% response) and ESA resistance (OR 3.85).
Conclusion: Serum hepcidin-25 demonstrates superior diagnostic accuracy compared to ferritin and predicts therapeutic responses in ACD. These findings support integrating hepcidin-25 into clinical practice, though assay standardization remains necessary.
