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The role of serum ferritin level and disease severity in COVID-19 with type 2 diabetes mellitus patients

  • Fauzia Noor Liani ,
  • Sony Wibisono Mudjanarko ,
  • Hermina Novida ,


Introduction: The disease progression of coronavirus disease 2019 (COVID-19) in individuals with comorbidities, such as type 2 diabetes mellitus (T2DM) in particular, has been associated with the occurrence of the cytokine storm. Ferritin, an acute-phase protein indicating inflammation, has been linked to T2DM and the severity of COVID-19. Our study aimed to investigate the association between the level of ferritin and the severity of COVID-19 in T2DM patients.

Methods: A cross-sectional study was conducted among COVID-19 patients admitted at Dr. Soetomo General Hospital, Surabaya, from April to September 2020. The patients who met the inclusion criteria were enrolled in the study. The data used in this study was secondary data obtained from the medical records at Dr. Soetomo General Hospital, which consisted of serum ferritin levels, the severity of COVID-19, the results of blood analysis, and other demographic and clinical characteristics (age, gender, hypertension, the number of complaints, and vital signs). Data analysis was performed using SPSS software and presented in percentage (%), mean ± standard deviation (SD), or median (min-max). A chi-square test was carried out to identify the association between serum ferritin level and the severity of COVID-19 in T2DM patients at α=0.05.

Results: Of the total 159 patients were included and 80.8% of them had moderate severity of COVID-19, whereas the rest (19.5%) had severe COVID-19. Out of total patients, 78.6% had ferritin levels of ≥400 mg/dL, suggesting hyperferritinemia syndrome (mean ± SD: 1177.21 ± 1275.90 mg/dL). The Chi-squared analysis revealed a significant association between serum ferritin levels with the severity of COVID-19 in T2DM patients (p=0.024).

Conclusion: There was a significant relationship between serum ferritin levels and the severity of COVID-19 in T2DM patients and further study with a bigger sample size is needed to confirm this finding.


  1. Fahriani M, Anwar S, Yufika A, Bakhtiar B, Wardani E, Winardi W, et al. Disruption of childhood vaccination during the COVID-19 pandemic in Indonesia. Narra J [Internet]. 2021;1(1). Available from:
  2. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis [Internet]. 2020/03/13. 2020;34:101623. Available from:
  3. Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H, et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health [Internet]. 2020/04/08. 2020 May;13(5):667–73. Available from:
  4. Triyono EA, Wahyuhadi J, Prajitno JH, Novida H, Siagian N, Cahyani C, et al. Clinical characteristics and outcomes of hospitalized COVID-19 patients with diabetes mellitus in East Java, Indonesia: A cross-sectional study. F1000Research [Internet]. 2022 Jun 21;11:684. Available from:
  5. Wang J, Meng W. COVID-19 and diabetes: the contributions of hyperglycemia. J Mol Cell Biol [Internet]. 2020 Sep 7;12(12):958–62. Available from:
  6. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol [Internet]. 2020/04/20. 2020 Jun;215:108427. Available from:
  7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England) [Internet]. 2020/03/11. 2020 Mar 28;395(10229):1054–62. Available from:
  8. Parasher A. COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment. Postgrad Med J [Internet]. 2020;97(1147):312–20. Available from:
  9. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England) [Internet]. 2020/01/24. 2020 Feb 15;395(10223):497–506. Available from:
  10. Mudatsir M, Fajar JK, Wulandari L, Soegiarto G, Ilmawan M, Purnamasari Y, et al. Predictors of COVID-19 severity: a systematic review and meta-analysis. F1000Research [Internet]. 2020 Sep 9;9:1107. Available from:
  11. Fahriani M, Ilmawan M, Fajar JK, Maliga HA, Frediansyah A, Masyeni S, et al. Persistence of long COVID symptoms in COVID-19 survivors worldwide and its potential pathogenesis - A systematic review and meta-analysis. Narra J [Internet]. 2021;1(2). Available from:
  12. Fajar JK, Ilmawan M, Mamada S, Mutiawati E, Husnah M, Yusuf H, et al. Global prevalence of persistent neuromuscular symptoms and the possible pathomechanisms in COVID-19 recovered individuals: A systematic review and meta-analysis. Narra J [Internet]. 2021;1(3). Available from:
  13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med [Internet]. 2020/02/28. 2020 Apr 30;382(18):1708–20. Available from:
  14. Wang L, Gao P, Zhang M, Huang Z, Zhang D, Deng Q, et al. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. JAMA [Internet]. 2017 Jun 27;317(24):2515–23. Available from:
  15. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA [Internet]. 2020 Mar 17;323(11):1061–9. Available from:
  16. Xu Z, Wang Z, Wang S, Ye Y, Luo D, Wan L, et al. The impact of type 2 diabetes and its management on the prognosis of patients with severe COVID-19. J Diabetes [Internet]. 2020/08/16. 2020 Dec;12(12):909–18. Available from:
  17. Lima-Martínez MM, Carrera Boada C, Madera-Silva MD, Marín W, Contreras M. COVID-19 and diabetes: A bidirectional relationship. Clínica e Investig en Arterioscler (English Ed [Internet]. 2021;33(3):151–7. Available from:
  18. Kusuma VP, Ardiany D. The Pathophysiology and Outcomes of Diabetic Patients with Coronavirus Disease 2019 (COVID-19). Biomol Heal Sci J [Internet]. 2021;4(2):124. Available from:
  19. Nadzifah YN, Hidajah AC. The relationship of diabetes mellitus and hypertension with mortality in covid-19 patients. J Berk Epidemiol [Internet]. 2022;10(2):219–26. Available from:
  20. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med [Internet]. 2020/02/24. 2020 May;8(5):475–81. Available from:
  21. Liu SP, Zhang Q, Wang W, Zhang M, Liu C, Xiao X, et al. Hyperglycemia is a strong predictor of poor prognosis in COVID-19. Diabetes Res Clin Pract [Internet]. 2020/07/24. 2020 Sep;167:108338. Available from:
  22. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev [Internet]. 2020 Mar 31;36(7):e3319–e3319. Available from:
  23. Soelistijo SA, Lindarto D, Decroli E, Permana H, Sucipto K, Kusnadi Y, et al. Guidelines for the management and prevention of type 2 diabetes mellitus in adults in Indonesia 2019. Indonesian Endocrinol Association. 2019;4:1-117.
  24. Azer SA. COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics. New microbes new Infect [Internet]. 2020/08/05. 2020 Sep;37:100738. Available from:
  25. Sackett K, Cunderlik M, Sahni N, Killeen AA, Olson APJ. Extreme Hyperferritinemia. Am J Clin Pathol [Internet]. 2016;145(5):646–50. Available from:
  26. Deng F, Zhang L, Lyu L, Lu Z, Gao D, Ma X, et al. Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19. Med Clin (English ed) [Internet]. 2021/04/01. 2021 Apr 9;156(7):324–31. Available from:
  27. Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics [Internet]. 2014;6(4):748–73. Available from:
  28. Taneri PE, Gómez-Ochoa SA, Llanaj E, Raguindin PF, Rojas LZ, Roa-Díaz ZM, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol [Internet]. 2020/08/20. 2020 Aug;35(8):763–73. Available from:
  29. Ahmad Z. Pathogenesis, Diagnosis and Management of Covid-19 [Internet]. Center for Open Science; 2021. Available from:
  30. Yan Y, Yang Y, Wang F, Ren H, Zhang S, Shi X, et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ open diabetes Res care [Internet]. 2020 Apr;8(1):e001343. Available from:
  31. Ma RCW, Holt RIG. COVID-19 and diabetes. Diabet Med [Internet]. 2020/04/03. 2020 May;37(5):723–5. Available from:
  32. Han M, Ma K, Wang X, Yan W, Wang H, You J, et al. Immunological Characteristics in Type 2 Diabetes Mellitus Among COVID-19 Patients. Front Endocrinol (Lausanne) [Internet]. 2021 Mar 11;12:596518. Available from:
  33. Zhang J jin, Dong X, Cao Y yuan, Yuan Y dong, Yang Y bin, Yan Y qin, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy [Internet]. 2020;75(7):1730–41. Available from:
  34. Corrao S, Pinelli K, Vacca M, Raspanti M, Argano C. Type 2 Diabetes Mellitus and COVID-19: A Narrative Review. Front Endocrinol (Lausanne) [Internet]. 2021 Mar 31;12:609470. Available from:
  35. Rahayu R, Winarto W, Nasihun T. Interleukin-6 and C-reactive Protein on Admission as Predictor of Mortality in Severe COVID-19 Patients: A Retrospective Cohort Study. Open Access Maced J Med Sci [Internet]. 2022;10(B):227–31. Available from:
  36. Roeroe PAL, Sedli BP, Umboh O. Faktor Risiko Terjadinya Coronavirus Disease 2019 (Covid-19) pada Penyandang Diabetes Melitus Tipe 2. e-CliniC [Internet]. 2021;9(1). Available from:
  37. Lestari N, Ichsan B. Diabetes mellitus as a risk factor for the severity and death of COVID-19 patients: Meta-analysis. biomedicine. 2021;13(1):83-94.
  38. 38. Rahayu LAD, Admiyanti JC, Khalda YI, Ahda FR, Agistany NFF, Setiawati S, et al. Hypertension, diabetes mellitus, and obesity as major comorbid factors for mortality in COVID-19 patients: a literature study. JIMKI J Ilm Mhs Kedokt Indonesia [Internet]. 2021;9(1):90–7. Available from:
  39. Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Res Clin Pract [Internet]. 2020/07/03. 2020 Aug;166:108293. Available from:
  40. Bozkurt FT, Tercan M, Patmano G, Bingol Tanrıverdi T, Demir HA, Yurekli UF. Can Ferritin Levels Predict the Severity of Illness in Patients With COVID-19? Cureus [Internet]. 2021 Jan 21;13(1):e12832–e12832. Available from:
  41. Kumar M, Bindu CM, Shyam AC, Reena R. Ferritin – The key model inflammatory marker in diabetic and non-diabetic COVID-19. Asian J Med Sci [Internet]. 2021;12(12):23–31. Available from:
  42. Cheng L, Li H, Li L, Liu C, Yan S, Chen H, et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal [Internet]. 2020/10/19. 2020 Oct;34(10):e23618–e23618. Available from:
  43. Darashkevich I, Mokhort T V, Kulaha A, Bahamazava N. Features of some metabolic and instrumental indices in patients with type 2 diabetes mellitus and COVID-19 in oxygen deficiency developed for the first time depending on the initial compensation. Endocr Abstr [Internet]. 2022; Available from:

How to Cite

Liani, F. N., Mudjanarko, S. W. ., & Novida, H. . (2022). The role of serum ferritin level and disease severity in COVID-19 with type 2 diabetes mellitus patients. Bali Medical Journal, 11(3), 1805–1810.




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Fauzia Noor Liani
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Sony Wibisono Mudjanarko
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Hermina Novida
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