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Original Article

Association between ferritin and high-sensitivity C-reactive protein levels and coronavirus disease 2019: a cross-sectional study

Farideh Shiraseb1,2orcid, Atieh Mirzababaei1,2orcid, Zeinab Zarrinvafa3orcid, Sajedeh Habibi1orcid, Rasool Ghaffarian Ensaf3orcid, Atousa Zandvakili4orcid, Khadijeh Mirzaei1orcid
Clinical Nutrition Research 2026;15(4):261-268.
Published online: October 31, 2026

1Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

2Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

3Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran

4Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran

Correspondence to: Khadijeh Mirzaei Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Keshavarz Blvd, Naderi St, Hojjat doost Alley, Tehran 1417613151, Iran Email: mirzaei_kh@sina.tums.ac.ir
Co-Correspondence to: Atieh Mirzababaei Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Keshavarz Blvd, Naderi St, Hojjat doost Alley, Tehran 1417613151, Iran Email: a_mirzababaei@tums.ac.ir
• Received: December 14, 2025   • Revised: July 17, 2026   • Accepted: July 18, 2026

© 2026 The Korean Society of Clinical Nutrition

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objective
    Coronavirus disease 2019 (COVID-19) manifests with various symptoms ranging from mild illness to multiorgan failure. Inflammatory markers such as ferritin and high-sensitivity C-reactive protein (hs-CRP) may impact disease severity and outcomes. This study explored the association between ferritin and hs-CRP levels and symptoms and duration of hospital stay in Iranian adult patients with COVID-19.
  • Methods
    This cross-sectional study included 107 patients with COVID-19 aged 20 to 60 years who were admitted to Amir Alam Hospital in Tehran, Iran. Serum levels of hs-CRP and ferritin were measured using immunoturbidimetric and enzyme-linked immunosorbent assay methods, according to the manufacturers’ protocols. Data regarding symptoms were collected using a demographic questionnaire and verified against their hospital records.
  • Results
    Marginally significant negative association was observed between hs-CRP and appetite (β=−0.001; 95% confidence interval [CI], −0.003 to 0.000; P=0.05). Lower odds of contusion related to higher ferritin levels were detected (odds ratio, 0.995; 95% CI, 0.990 to 1.000; P=0.05).
  • Conclusion
    Serum levels of hs-CRP and ferritin are probably associated with some clinical symptoms in patients with COVID-19. Higher hs-CRP levels were possibly associated with lower appetite, and higher ferritin levels were inversely associated with contusion.
  • Keywords: Ferritins; C-reactive protein; COVID-19
Since December 2019, the coronavirus disease 2019 (COVID-19) pandemic has affected a large number of individuals across all age groups from newborns to the elderly [1,2]. Iran was among the countries most severely affected by COVID-19, with more than 6.6 million confirmed cases and approximately 140,000 deaths reported by February 2022, making it one of the hardest-hit countries in the Middle East [3]. The clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection varies from mild or asymptomatic cases to severe acute pneumonia, which can cause serious lung damage, an increased risk for multiple organ failure and death [4]. The duration of hospital stay is a clinical factor in determining the prognosis of COVID-19 [5].
The severe outcomes and multiorgan damage experienced by patients with COVID-19 are probably due to the inflammatory process triggered by SARS-CoV-2 infection [6]. Several inflammatory markers, including ferritin [7] and high-sensitivity C-reactive protein (hs-CRP) [8], may affect the progression of COVID-19. Ferritin is an acute-phase reactant and associated with both acute and chronic inflammation and/or infection [9,10]. Increased ferritin levels are more commonly detected in patients with impaired lung function and strongly correlate with delayed recovery in patients with COVID-19 [7]. Furthermore, serum hs-CRP levels may be a useful marker for evaluating disease progression and prognosis in patients with COVID-19 [11].
Although increased hs-CRP and ferritin levels are associated with severe COVID-19 outcomes, there exists a gap in the literature concerning the combined effect of these biomarkers on both clinical symptoms and hospitalization duration. Most previous research has investigated biomarkers individually and reported mixed results [8]. However, a few studies have comprehensively examined how these biomarkers interact to affect patient prognosis, thus emphasizing the need for further investigation. Therefore, this study was conducted to investigate the associations between ferritin and hs-CRP levels and hospital stay duration and symptom severity in patients with COVID-19.
Study design and population
This cross-sectional study recruited 107 Iranian adults aged 20 to 60 years, diagnosed with COVID-19, who were referred to Amir Alam Hospital in Tehran, Iran, in 2020. Participants were selected from the patient list according to their diagnosis using convenience sampling. Inclusion criteria were men and women aged 20 to 60 years with COVID-19 confirmed by reverse transcription polymerase chain reaction testing of nasopharyngeal and oropharyngeal samples and the presence of symptoms such as fever, chills, sore throat, sneezing, shortness of breath, chest pain, and other common symptoms. Data regarding the symptoms of patients were collected using a demographic questionnaire by a trained individual and verified against their hospital records. Exclusion criteria included preexisting liver or kidney diseases, rare viral infections such as human immunodeficiency virus, and recent chemotherapy (within the past month). Biochemical examination, including hs-CRP and D-dimer levels, was also performed. All patients were diagnosed with COVID-19 according to the World Health Organization interim guidance, which confirms acute SARS-CoV-2 infections based on the detection of unique viral sequences using nucleic acid amplification tests. The discharge criteria were absence of fever for at least 3 days, substantial improvement in both lungs detected on chest computed tomography, clinical remission of respiratory symptoms, and two negative throat swab samples obtained at least 24 hours apart. All participants received a written informed consent form with a description of the study methods and goals. The research protocol was approved by the Ethics Committee of Tehran University of Medical Sciences (TUMS) (No. IR.TUMS.MEDICINE.REC.1399.433), and all patients signed the written consent form.
Data collection
Data regarding the demographic characteristics of study participants, including age, marital status, education, employment, housing and income status, and obesity family history, were collected using a general structured and closed-ended questionnaire. The duration of hospitalization was determined by inquiring participants about the number of days spent in the hospital. A Seca digital scale (Germany) with a 0.1-kg precision was used to determine participants’ body weight. Height was measured using a Seca 206 stadiometer (Germany) with a 0.1-cm precision.
Biochemical measurements
After a 10- to 12-hour fast, 12 mL of venous blood sample was collected from each study participant. The blood sample was divided into two tubes, with one containing the anticoagulant ethylenediaminetetraacetic acid (EDTA) and the other without EDTA. After centrifugation for 15 minutes, half of the serum sample without the anticoagulant was stored at −80 °C. All tests were conducted according to the manufacturer’s instructions. Serum hs-CRP levels (mg/L) were measured by immunoturbidimetric testing using a Pars Azmoon kit (Pars Azmoon Inc.), and ferritin levels (ng/mL) were measured using an enzyme-linked immunosorbent assay kit (AccuBind, Monobind Inc.).
Statistical analysis
Data analysis was performed using the IBM SPSS ver. 27 (IBM Corp.). The Kolmogorov-Smirnov test was used to determine the normal distribution of continuous variables (P>0.05). Continuous variables are reported as mean and standard deviation, and categorical variables are reported as numbers and percentages. One-way analysis of variance and chi-square tests were used to compare continuous and categorical variables, respectively. The analysis of covariance was used to adjust for confounding variables. Linear regression analysis was used to determine associations between hospitalization duration, recovery time, smell, taste, appetite, and lethargy, and results were reported as beta coefficients (β) with 95% confidence intervals (CIs). Binary logistic regression was used to determine associations between chest pain, headache, rhinitis, vomiting, nausea, diarrhea, sore throat, joint pain, stomachache, confusion, contusion, fever, chills, and respiratory distress syndrome (RDS), and results were expressed as odds ratios (OR) along with 95% CIs. Two analysis models were developed. Model 1 was adjusted for age, sex, education level, body mass index (BMI), and physical activity. Model 2 included additional adjustments for comorbidity, medication use, and supplementation intake. In the binary logistic regression, the absence of symptoms, including chest pain, headache, nasal issues, vomiting, nausea, diarrhea, sore throat, joint pain, stomachache, confusion, contusion, fever, chills, and RDS, was considered the reference group. P<0.05 was considered statistically significant, and P-values of 0.05–0.07 were interpreted as marginally significant in this study.
Study population characteristics
This cross-sectional study included 107 Iranian men and women. Most participants were married (88.6%), employed (33.3%), had a bachelor’s degree (47.6%), had no history of medication use (56.0%), and had no history of disease (49.5%). Their general characteristics are presented in Table 1.
Associations between ferritin and hs-CRP levels and COVID-19 symptoms and hospital stay duration
The association between ferritin and hs-CRP levels with symptoms and hospital stay duration of patients with COVID-19 is shown in Table 2. After adjusting for confounders, including age, sex, educational level, BMI, and physical activity, a marginally significant negative association was observed between hs-CRP levels and appetite in model 1 (β=−0.001; 95% CI, −0.003 to 0.000; P=0.05). In model 2, after further controlling for covariates such as comorbidity, medication use, and supplementation intake, a marginally significant negative association was found between hs-CRP levels and appetite (β=−0.001; 95% CI, −0.003 to 0.000; P=0.05) (Table 2).
Associations between ferritin and hs-CRP levels and symptoms and hospital stay duration in patients with COVID-19
The association between ferritin and hs-CRP levels and COVID-19 symptoms is depicted in Table 3. In the crude model, marginally significant lower odds of headache with higher ferritin levels were detected (OR, 0.996; 95% CI, 0.992 to 1.000; P=0.07). After controlling for confounders, this association disappeared. Moreover, in the crude model, significantly higher odds of joint pain in patients with higher ferritin levels were observed (OR, 1.003; 95% CI, 1.002 to 1.011; P=0.04). Nonetheless, the significant association disappeared after adjusting for confounding variables in model 2 (Table 3).
Significantly lower odds of contusion were detected in individuals with higher ferritin levels in both the crude model (OR, 0.996; 95% CI, 0.992 to 1.000; P=0.03) and model 1 (OR, 0.995; 95% CI, 0.991 to 1.000; P=0.03). In model 2, marginally significantly lower odds of contusion with higher ferritin levels were observed (OR, 0.995; 95% CI, 0.990 to 1.000; P=0.05). In the crude model, marginally significant lower odds of chills with higher ferritin levels were detected (OR, 0.997; 95% CI, 0.995 to 1.000; P=0.07), which disappeared after adjustment in models 1 and 2 (Table 3).
To our knowledge, this is the first study to investigate the associations between ferritin and hs-CRP levels and symptoms and hospital stay duration in patients with COVID-19. We observed a negative association between hs-CRP levels and appetite. Moreover, patients with higher ferritin levels had lower odds of contusion.
An observational study conducted by Kurian et al. [12] on hospitalized adult patients with confirmed COVID-19 infection in a tertiary healthcare facility reported that patients with ferritin levels >287.4 ng/mL had a higher risk of developing moderate-to-severe COVID-19, indicating a positive association between serum ferritin levels and disease severity. Furthermore, a systematic review and meta-analysis by Kaushal et al. [13] reported a significant association between serum ferritin levels and severe COVID-19 outcomes, thereby supporting the role of ferritin as a predictive biomarker of disease severity.
In our study, a negative association was found between hs-CRP levels and appetite, which may have important implications from a clinical nutrition perspective. Reduced appetite is a common consequence of systemic inflammation and has frequently been reported in patients with COVID-19. Proinflammatory cytokines can affect central appetite regulation, resulting in decreased food intake during the course of illness [14]. If prolonged, this reduction in appetite may contribute to insufficient energy and protein intake, increasing the risk for malnutrition, unintended weight loss, and loss of muscle mass, all of which may adversely impact recovery and clinical outcomes [15]. Consistent with our findings, two studies reported that patients with COVID-19 experience lower appetite and elevated hs-CRP levels. Dantzer et al. [16] reviewed the mechanisms by which systemic inflammation affects appetite and behavior. They explained that proinflammatory cytokines, including interleukin (IL)-6 and tumor necrosis factor (TNF)-α, can act on the hypothalamus, suppressing orexigenic signals such as ghrelin and improving anorexigenic signals such as leptin. This cytokine-mediated pathway reduces appetite (anorexia) during infection or inflammatory conditions. These data provide a mechanistic basis for the negative association between inflammatory markers, such as hs-CRP, and appetite observed in clinical studies [17,18].
Pepys and Hirschfield [19] provided a comprehensive update on CRP, emphasizing its role as an acute-phase protein and biomarker of systemic inflammation. They highlighted that increased CRP levels indicate ongoing inflammatory activity and are closely associated with proinflammatory cytokines. Although CRP itself does not directly regulate appetite, an increase in its levels indicates systemic inflammation, which can indirectly suppress appetite through hypothalamic and cytokine-mediated pathways [17,18].
Consistent with previous findings, increased hs-CRP levels indicate systemic inflammation, which can affect the hypothalamic regulation of hunger. Proinflammatory cytokines such as IL-6 and TNF-α, whose levels often increase along with hs-CRP levels, can suppress orexigenic signals (ghrelin) and improve anorexigenic signals (leptin), thereby reducing appetite [16]. Therefore, the observed negative association is probably indirect, mediated through systemic inflammation rather than a direct effect of hs-CRP itself. These findings are consistent with previous studies linking inflammatory markers to anorexia in infectious and inflammatory conditions, including COVID-19 [19].
Although some crude associations were found between ferritin levels and specific symptoms such as joint pain and chills, these associations disappeared after adjusting for confounders, emphasizing that individual symptom expression may depend on multiple factors beyond systemic inflammation. These data are consistent with previous research demonstrating that inflammatory markers are more strongly associated with overall disease severity than with individual symptom manifestation.
From a clinical perspective, our findings underscore the importance of monitoring hs-CRP levels and ferritin in patients with COVID-19 as indicators of inflammatory burden, which may affect nutritional status and appetite. Interventions that reduce systemic inflammation could potentially improve appetite and clinical outcomes, especially in patients at risk of malnutrition.
This study has several strengths. It specifically focused on Iranian patients, advancing the knowledge of their specific health experiences and clinical profiles. Moreover, to increase the accuracy of assessments, the analysis was adjusted for multiple potential confounding factors. Nevertheless, there were potential limitations in this study. First, its cross-sectional design limits the ability to establish causal relationship. Second, the small sample size may limit the statistical power and generalizability of the findings. Third, the use of self-reported anthropometric data may have introduced measurement bias, affecting the precision of analyses. Finally, generalizability is limited due to the study’s focus on patients from a single hospital setting. Although we conducted statistical adjustments for potential confounders, residual confounding cannot be entirely eliminated and may have influenced the observed associations.
In conclusion, increased hs-CRP levels are negatively associated with appetite, and higher ferritin levels are associated with lower odds of contusions in patients with COVID-19. Hence, systemic inflammation, reflected by hs-CRP and ferritin levels, may influence appetite and certain clinical manifestations, underscoring the potential value of monitoring these biomarkers to guide nutritional and clinical management. Further longitudinal studies with larger sample sizes are necessary to confirm these associations and clarify the causal relationships.

Author Contributions

Conceptualization: KM. Data curation: FS. Formal analysis: FS. Investigation: FS, ZZ, RGE, AZ, SH. Methodology: KM. Supervision: AM, KM. Writing - original draft: FS, ZZ, RGE, AZ, SH. Writing – review & editing: all authors. All authors read and approved the final manuscript.

Conflict of Interest

None.

Funding

This study was supported by Tehran University of Medical Sciences (Grant No: 1401-2-212-58098).

Acknowledgments

This study was supported by the Tehran University of Medical Sciences. We thank all patients in Amir Alam Hospital.

Data availability

The data that support the findings of this study are available from Dr. Khadijeh Mirzaei but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Dr. Khadijeh Mirzaei.

Table 1.
General characteristics of the study participants (n=107)
Table 1.
Characteristic Value
Age (yr) 46.21±11.37
Height (cm) 170.92±8.05
Weight (kg) 86.75±13.49
BMI (kg/m2) 29.63±3.66
hs-CRP (mg/L) 63.30±98.14
Ferritin (ng/mL) 243.55±289.06
RDS, yes 23 (21.9)
Fever, yes 76 (72.4)
Shivering, yes 65 (61.9)
Confusion, yes 32 (30.5)
Sore throat, yes 34 (32.4)
Rhinitis, yes 44 (41.9)
Diarrhea, yes 24 (22.9)
Nausea, yes 45 (42.9)
Vomiting, yes 14 (13.3)
Headache, yes 54 (51.4)
Chest pain, yes 54 (51.4)
Stomachache, yes 18 (17.1)
Joint pain, yes 67 (63.8)
Sex
 Male 69 (65.7)
 Female 36 (34.3)
Marital status, married 93 (88.6)
Education status
 High school education 24 (22.9)
 Bachelor’s degree 50 (47.6)
 Other 31 (29.5)
Joba)
 Employed 8 (33.3)
 Unemployed 40 (32.4)

Values are presented as mean±standard deviation or number (%). Data were missing for 2 participants.

BMI, body mass index; hs-CRP, high-sensitivity C-reactive protein; RDS, respiratory distress syndrome.

a)Employment status data were unavailable for some participants due to nonresponse.

Table 2.
Associations between ferritin and hs-CRP levels and hospital stay duration and coronavirus disease 2019 symptoms (n=107)
Table 2.
Variable Ferritin (ng/mL) P-value hs-CRP (mg/L) P-value
β (95% CI) β (95% CI)
Hospitalization day
 DH (day)
  Crude 0.000 (−0.001 to 0.002) 0.70 0.000 (−0.002 to 0.001) 0.88
  Model 1 0.000 (−0.001 to 0.002) 0.74 0.000 (−0.002 to 0.001) 0.90
  Model 2 0.000 (−0.002 to 0.002) 0.99 0.000 (−0.001 to 0.002) 0.85
 Recovery time (day)
  Crude −0.001 (−0.003 to 0.002) 0.56 0.001 (−0.002 to 0.003) 0.51
  Model 1 −0.002 (−0.004 to 0.000) 0.90 0.002 (−0.001 to 0.004) 0.32
  Model 2 −0.003 (−0.005 to 0.000) 0.42 0.002 (−0.001 to 0.004) 0.14
Symptom
 Smell
  Crude −0.001 (−0.003 to 0.001) 0.26 0.000 (−0.002 to 0.002) 0.95
  Model 1 −0.001 (−0.003 to 0.001) 0.23 0.000 (−0.002 to 0.002) 0.93
  Model 2 −0.001 (−0.003 to 0.001) 0.38 0.000 (−0.002 to 0.002) 0.84
 Taste
  Crude −0.001 (−0.003 to 0.001) 0.35 −0.001 (−0.003 to 0.001) 0.29
  Model 1 −0.001 (−0.003 to 0.001) 0.27 −0.001 (−0.003 to 0.001) 0.30
  Model 2 −0.001 (−0.003 to 0.001) 0.42 −0.001 (−0.003 to 0.001) 0.37
 Appetite
  Crude 0.001 (−0.001 to 0.002) 0.42 −0.001 (−0.003 to 0.000) 0.09
  Model 1 0.001 (−0.001 to 0.002) 0.31 −0.001 (−0.003 to 0.000) 0.05*
  Model 2 0.001 (−0.001 to 0.002) 0.42 −0.001 (−0.003 to 0.000) 0.05*
 Lethargy
  Crude 0.000 (−0.001 to 0.002) 0.61 0.001 (−0.001 to 0.002) 0.33
  Model 1 0.000 (−0.001 to 0.002) 0.67 0.001 (−0.001 to 0.002) 0.41
  Model 2 0.000 (−0.001 to 0.002) 0.86 0.001 (−0.001 to 0.002) 0.74

Data were obtained from linear regression. Model 1 was adjusted for age, sex, education level, body mass index (BMI), and physical activity. Model 2 was adjusted for age, sex, education level, BMI, physical activity, comorbidity, medication use, and supplement consumption.

hs-CRP, high-sensitivity C-reactive protein; DH, duration of hospitalization.

*P<0.05 was considered statistically significant. P-values from 0.05 to 0.07 were considered marginally significant.

Table 3.
Associations between ferritin and hs-CRP levels and the odds ratio for symptoms in patients with coronavirus disease 2019 (n=107)
Table 3.
Variable Ferritin (ng/mL) P-value hs-CRP (mg/L) P-value
OR (95% CI) OR (95% CI)
Chest pain
 Crude 0.996 (0.992 to 1.001) 0.09 1.002 (0.996 to 1.008) 0.47
 Model 1 0.997 (0.992 to 1.001) 0.15 1.002 (0.996 to 1.008) 0.44
 Model 2 0.997 (0.992 to 1.002) 0.27 1.002 (0.996 to 1.008) 0.49
Headache
 Crude 0.996 (0.992 to 1.000) 0.07* 1.000 (0.995 to 1.004) 0.83
 Model 1 0.995 (0.990 to 1.001) 0.08 1.000 (0.995 to 1.001) 0.98
 Model 2 0.995 (0.990 to 1.001) 0.63 1.001 (0.996 to 1.006) 0.78
Rhinitis
 Crude 1.000 (0.998 to 1.002) 0.97 0.998 (0.992 to 1.004) 0.50
 Model 1 1.000 (0.997 to 1.002) 0.85 0.998 (0.992 to 1.004) 0.58
 Model 2 1.000 (0.996 to 1.003) 0.82 0.999 (0.993 to 1.006) 0.78
Vomiting
 Crude 1.003 (0.997 to 1.003) 0.98 0.991 (0.973 to 1.008) 0.29
 Model 1 1.003 (0.998 to 1.008) 0.20 0.985 (0.964 to 1.006) 0.16
 Model 2 1.003 (0.998 to 1.008) 0.20 0.981 (0.965 to 1.007) 0.14
Nausea
 Crude 0.999 (0.996 to 1.001) 0.26 0.994 (0.985 to 1.004) 0.22
 Model 1 0.999 (0.996 to 1.002) 0.40 0.993 (0.982 to 1.004) 0.22
 Model 2 1.004 (0.997 to 1.011) 0.32 0.991 (0.976 to 1.005) 0.21
Diarrhea
 Crude 0.992 (0.981 to 1.003) 0.15 0.994 (0.983 to 1.006) 0.34
 Model 1 0.994 (0.981 to 1.006) 0.31 0.993 (0.979 to 1.007) 0.32
 Model 2 0.994 (0.981 to 1.006) 1.00 0.991 (0.973 to 1.008) 0.29
Sore throat
 Crude 1.000 (0.998 to 1.003) 0.55 0.998 (0.992 to 1.005) 0.60
 Model 1 1.000 (0.998 to 1.004) 0.53 0.998 (0.992 to 1.005) 0.60
 Model 2 1.000 (0.997 to 1.004) 0.87 0.998 (0.992 to 1.005) 0.62
Joint pain
 Crude 1.003 (1.002 to 1.011) 0.04* 1.002 (0.996 to 1.008) 0.51
 Model 1 1.004 (1.003 to 1.011) 0.07* 1.003 (0.996 to 1.009) 0.41
 Model 2 1.004 (1.004 to 1.011) 0.08 1.003 (0.997 to 1.002) 0.39
Stomachache
 Crude 0.999 (0.999 to 1.000) 0.99 1.001 (0.996 to 1.006) 0.58
 Model 1 0.999 (0.999 to 1.000) 0.99 1.001 (0.996 to 1.006) 0.76
 Model 2 1.000 (0.999 to 1.010) 0.88 1.001 (0.996 to 1.007) 0.68
Confusion
 Crude 1.000 (0.998 to 1.003) 0.80 0.998 (0.991 to 1.005) 0.50
 Model 1 1.001 (0.990 to 1.004) 0.48 0.995 (0.984 to 1.003) 0.99
 Model 2 0.999 (0.994 to 1.003) 0.48 1.000 (0.999 to 1.002) 0.47
Contusion
 Crude 0.996 (0.992 to 1.000) 0.03* 1.000 (0.998 to 1.001) 0.67
 Model 1 0.995 (0.991 to 1.000) 0.03* 1.000 (0.998 to 1.001) 0.80
 Model 2 0.995 (0.990 to 1.000) 0.05* 1.000 (0.998 to 1.001) 0.52
Fever
 Crude 0.999 (0.996 to 1.001) 0.26 0.999 (0.998 to 1.000) 0.11
 Model 1 0.998 (0.996 to 1.001) 0.27 0.999 (0.998 to 1.000) 0.11
 Model 2 0.994 (0.985 to 1.002) 0.13 0.999 (0.998 to 1.000) 0.09
Chills
 Crude 0.997 (0.995 to 1.000) 0.07* 1.000 (0.999 to 1.001) 0.35
 Model 1 0.997 (0.994 to 1.001) 0.12 1.000 (0.998 to 1.001) 0.49
 Model 2 0.996 (0.991 to 1.001) 0.11 1.000 (0.998 to 1.001) 0.43
RDS
 Crude 1.001 (0.998 to 1.003) 0.50 1.001 (0.999 to 1.002) 0.34
 Model 1 1.001 (0.998 to 1.004) 0.52 1.001 (0.999 to 1.002) 0.34
 Model 2 1.002 (0.996 to 1.008) 0.44 1.001 (0.999 to 1.002) 0.38

Data were obtained from binary logistic regression. Absence of symptoms, including chest pain, headache, nasal issues, vomiting, nausea, diarrhea, sore throat, joint pain, stomachache, confusion, contusion, fever, chills, and RDS, was considered the reference group. Ferritin and hs-CRP levels lower than median were considered the reference group. Model 1 was adjusted for age, sex, education level, body mass index (BMI), and physical activity. Model 2 was adjusted for age, sex, education level, BMI, physical activity, comorbidity, medication use, and supplement consumption.

hs-CRP, high-sensitivity C-reactive protein; RDS, respiratory distress syndrome.

*P<0.05 was considered statistically significant. P-values of 0.05–0.07 were considered marginally significant.

  • 1. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020;145:e20200702.
  • 2. Cui X, Zhang T, Zheng J, et al. Children with coronavirus disease 2019: a review of demographic, clinical, laboratory, and imaging features in pediatric patients. J Med Virol 2020;92:1501-10.
  • 3. World Health Organization. Response to COVID-19 in Iran: impact story [Internet]. World Health Organization; 2022 [cited 2025 Oct 28]. Available from: https://www.who.int/about/accountability/results/who-results-report-2020-2021/country-story/2021/iran
  • 4. Parasher A. COVID-19: current understanding of its pathophysiology, clinical presentation and treatment. Postgrad Med J 2021;97:312-20.
  • 5. Mahmood ZS, Fadhil HY, Abdul Hussein TA, Ad'hiah AH. Severity of coronavirus disease 19: profile of inflammatory markers and ACE (rs4646994) and ACE2 (rs2285666) gene polymorphisms in Iraqi patients. Meta Gene 2022;31:101014.
  • 6. Hadi JM, Mohammad HM, Ahmed AY, et al. Investigation of serum ferritin for the prediction of COVID-19 severity and mortality: a cross-sectional study. Cureus 2022;14:e31982.
  • 7. Vargas-Vargas M, Cortes-Rojo C. Ferritin levels and COVID-19. Rev Panam Salud Publica 2020;44:e72.
  • 8. Martinez Chamorro E, Diez Tascon A, Ibanez Sanz L, Ossaba Velez S, Borruel Nacenta S. Radiologic diagnosis of patients with COVID-19. Radiologia (Engl Ed) 2021;63:56-73.
  • 9. Mahroum N, Alghory A, Kiyak Z, et al. Ferritin: from iron, through inflammation and autoimmunity, to COVID-19. J Autoimmun 2022;126:102778.
  • 10. Banchini F, Cattaneo GM, Capelli P. Serum ferritin levels in inflammation: a retrospective comparative analysis between COVID-19 and emergency surgical non-COVID-19 patients. World J Emerg Surg 2021;16:9.
  • 11. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis 2020;14:1753466620937175.
  • 12. Kurian SJ, Mathews SP, Paul A, et al. Association of serum ferritin with severity and clinical outcome in COVID-19 patients: an observational study in a tertiary healthcare facility. Clin Epidemiol Glob Health 2023;21:101295.
  • 13. Kaushal K, Kaur H, Sarma P, et al. Serum ferritin as a predictive biomarker in COVID-19: a systematic review, meta-analysis and meta-regression analysis. J Crit Care 2022;67:172-81.
  • 14. Plata-Salaman CR. Cytokines and feeding. Int J Obes Relat Metab Disord 2001;25 Suppl 5:S48-52.
  • 15. Barazzoni R, Bischoff SC, Breda J, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr 2020;39:1631-8.
  • 16. Dantzer R, O'Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 2008;9:46-56.
  • 17. Li Q, Ding X, Xia G, et al. Eosinopenia and elevated C-reactive protein facilitate triage of COVID-19 patients in fever clinic: a retrospective case-control study. EClinicalMedicine 2020;23:100375.
  • 18. Li T, Zhang Y, Gong C, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr 2020;74:871-5.
  • 19. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003;111:1805-12.

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Association between ferritin and high-sensitivity C-reactive protein levels and coronavirus disease 2019: a cross-sectional study
Clin Nutr Res. 2026;15(4):261-268.   Published online October 31, 2026
DOI: https://doi.org/10.7762/cnr.2025.0034
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Association between ferritin and high-sensitivity C-reactive protein levels and coronavirus disease 2019: a cross-sectional study
Clin Nutr Res. 2026;15(4):261-268.   Published online October 31, 2026
DOI: https://doi.org/10.7762/cnr.2025.0034
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Association between ferritin and high-sensitivity C-reactive protein levels and coronavirus disease 2019: a cross-sectional study
Association between ferritin and high-sensitivity C-reactive protein levels and coronavirus disease 2019: a cross-sectional study
Characteristic Value
Age (yr) 46.21±11.37
Height (cm) 170.92±8.05
Weight (kg) 86.75±13.49
BMI (kg/m2) 29.63±3.66
hs-CRP (mg/L) 63.30±98.14
Ferritin (ng/mL) 243.55±289.06
RDS, yes 23 (21.9)
Fever, yes 76 (72.4)
Shivering, yes 65 (61.9)
Confusion, yes 32 (30.5)
Sore throat, yes 34 (32.4)
Rhinitis, yes 44 (41.9)
Diarrhea, yes 24 (22.9)
Nausea, yes 45 (42.9)
Vomiting, yes 14 (13.3)
Headache, yes 54 (51.4)
Chest pain, yes 54 (51.4)
Stomachache, yes 18 (17.1)
Joint pain, yes 67 (63.8)
Sex
 Male 69 (65.7)
 Female 36 (34.3)
Marital status, married 93 (88.6)
Education status
 High school education 24 (22.9)
 Bachelor’s degree 50 (47.6)
 Other 31 (29.5)
Joba)
 Employed 8 (33.3)
 Unemployed 40 (32.4)
Variable Ferritin (ng/mL) P-value hs-CRP (mg/L) P-value
β (95% CI) β (95% CI)
Hospitalization day
 DH (day)
  Crude 0.000 (−0.001 to 0.002) 0.70 0.000 (−0.002 to 0.001) 0.88
  Model 1 0.000 (−0.001 to 0.002) 0.74 0.000 (−0.002 to 0.001) 0.90
  Model 2 0.000 (−0.002 to 0.002) 0.99 0.000 (−0.001 to 0.002) 0.85
 Recovery time (day)
  Crude −0.001 (−0.003 to 0.002) 0.56 0.001 (−0.002 to 0.003) 0.51
  Model 1 −0.002 (−0.004 to 0.000) 0.90 0.002 (−0.001 to 0.004) 0.32
  Model 2 −0.003 (−0.005 to 0.000) 0.42 0.002 (−0.001 to 0.004) 0.14
Symptom
 Smell
  Crude −0.001 (−0.003 to 0.001) 0.26 0.000 (−0.002 to 0.002) 0.95
  Model 1 −0.001 (−0.003 to 0.001) 0.23 0.000 (−0.002 to 0.002) 0.93
  Model 2 −0.001 (−0.003 to 0.001) 0.38 0.000 (−0.002 to 0.002) 0.84
 Taste
  Crude −0.001 (−0.003 to 0.001) 0.35 −0.001 (−0.003 to 0.001) 0.29
  Model 1 −0.001 (−0.003 to 0.001) 0.27 −0.001 (−0.003 to 0.001) 0.30
  Model 2 −0.001 (−0.003 to 0.001) 0.42 −0.001 (−0.003 to 0.001) 0.37
 Appetite
  Crude 0.001 (−0.001 to 0.002) 0.42 −0.001 (−0.003 to 0.000) 0.09
  Model 1 0.001 (−0.001 to 0.002) 0.31 −0.001 (−0.003 to 0.000) 0.05*
  Model 2 0.001 (−0.001 to 0.002) 0.42 −0.001 (−0.003 to 0.000) 0.05*
 Lethargy
  Crude 0.000 (−0.001 to 0.002) 0.61 0.001 (−0.001 to 0.002) 0.33
  Model 1 0.000 (−0.001 to 0.002) 0.67 0.001 (−0.001 to 0.002) 0.41
  Model 2 0.000 (−0.001 to 0.002) 0.86 0.001 (−0.001 to 0.002) 0.74
Variable Ferritin (ng/mL) P-value hs-CRP (mg/L) P-value
OR (95% CI) OR (95% CI)
Chest pain
 Crude 0.996 (0.992 to 1.001) 0.09 1.002 (0.996 to 1.008) 0.47
 Model 1 0.997 (0.992 to 1.001) 0.15 1.002 (0.996 to 1.008) 0.44
 Model 2 0.997 (0.992 to 1.002) 0.27 1.002 (0.996 to 1.008) 0.49
Headache
 Crude 0.996 (0.992 to 1.000) 0.07* 1.000 (0.995 to 1.004) 0.83
 Model 1 0.995 (0.990 to 1.001) 0.08 1.000 (0.995 to 1.001) 0.98
 Model 2 0.995 (0.990 to 1.001) 0.63 1.001 (0.996 to 1.006) 0.78
Rhinitis
 Crude 1.000 (0.998 to 1.002) 0.97 0.998 (0.992 to 1.004) 0.50
 Model 1 1.000 (0.997 to 1.002) 0.85 0.998 (0.992 to 1.004) 0.58
 Model 2 1.000 (0.996 to 1.003) 0.82 0.999 (0.993 to 1.006) 0.78
Vomiting
 Crude 1.003 (0.997 to 1.003) 0.98 0.991 (0.973 to 1.008) 0.29
 Model 1 1.003 (0.998 to 1.008) 0.20 0.985 (0.964 to 1.006) 0.16
 Model 2 1.003 (0.998 to 1.008) 0.20 0.981 (0.965 to 1.007) 0.14
Nausea
 Crude 0.999 (0.996 to 1.001) 0.26 0.994 (0.985 to 1.004) 0.22
 Model 1 0.999 (0.996 to 1.002) 0.40 0.993 (0.982 to 1.004) 0.22
 Model 2 1.004 (0.997 to 1.011) 0.32 0.991 (0.976 to 1.005) 0.21
Diarrhea
 Crude 0.992 (0.981 to 1.003) 0.15 0.994 (0.983 to 1.006) 0.34
 Model 1 0.994 (0.981 to 1.006) 0.31 0.993 (0.979 to 1.007) 0.32
 Model 2 0.994 (0.981 to 1.006) 1.00 0.991 (0.973 to 1.008) 0.29
Sore throat
 Crude 1.000 (0.998 to 1.003) 0.55 0.998 (0.992 to 1.005) 0.60
 Model 1 1.000 (0.998 to 1.004) 0.53 0.998 (0.992 to 1.005) 0.60
 Model 2 1.000 (0.997 to 1.004) 0.87 0.998 (0.992 to 1.005) 0.62
Joint pain
 Crude 1.003 (1.002 to 1.011) 0.04* 1.002 (0.996 to 1.008) 0.51
 Model 1 1.004 (1.003 to 1.011) 0.07* 1.003 (0.996 to 1.009) 0.41
 Model 2 1.004 (1.004 to 1.011) 0.08 1.003 (0.997 to 1.002) 0.39
Stomachache
 Crude 0.999 (0.999 to 1.000) 0.99 1.001 (0.996 to 1.006) 0.58
 Model 1 0.999 (0.999 to 1.000) 0.99 1.001 (0.996 to 1.006) 0.76
 Model 2 1.000 (0.999 to 1.010) 0.88 1.001 (0.996 to 1.007) 0.68
Confusion
 Crude 1.000 (0.998 to 1.003) 0.80 0.998 (0.991 to 1.005) 0.50
 Model 1 1.001 (0.990 to 1.004) 0.48 0.995 (0.984 to 1.003) 0.99
 Model 2 0.999 (0.994 to 1.003) 0.48 1.000 (0.999 to 1.002) 0.47
Contusion
 Crude 0.996 (0.992 to 1.000) 0.03* 1.000 (0.998 to 1.001) 0.67
 Model 1 0.995 (0.991 to 1.000) 0.03* 1.000 (0.998 to 1.001) 0.80
 Model 2 0.995 (0.990 to 1.000) 0.05* 1.000 (0.998 to 1.001) 0.52
Fever
 Crude 0.999 (0.996 to 1.001) 0.26 0.999 (0.998 to 1.000) 0.11
 Model 1 0.998 (0.996 to 1.001) 0.27 0.999 (0.998 to 1.000) 0.11
 Model 2 0.994 (0.985 to 1.002) 0.13 0.999 (0.998 to 1.000) 0.09
Chills
 Crude 0.997 (0.995 to 1.000) 0.07* 1.000 (0.999 to 1.001) 0.35
 Model 1 0.997 (0.994 to 1.001) 0.12 1.000 (0.998 to 1.001) 0.49
 Model 2 0.996 (0.991 to 1.001) 0.11 1.000 (0.998 to 1.001) 0.43
RDS
 Crude 1.001 (0.998 to 1.003) 0.50 1.001 (0.999 to 1.002) 0.34
 Model 1 1.001 (0.998 to 1.004) 0.52 1.001 (0.999 to 1.002) 0.34
 Model 2 1.002 (0.996 to 1.008) 0.44 1.001 (0.999 to 1.002) 0.38
Table 1. General characteristics of the study participants (n=107)

Values are presented as mean±standard deviation or number (%). Data were missing for 2 participants.

BMI, body mass index; hs-CRP, high-sensitivity C-reactive protein; RDS, respiratory distress syndrome.

Employment status data were unavailable for some participants due to nonresponse.

Table 2. Associations between ferritin and hs-CRP levels and hospital stay duration and coronavirus disease 2019 symptoms (n=107)

Data were obtained from linear regression. Model 1 was adjusted for age, sex, education level, body mass index (BMI), and physical activity. Model 2 was adjusted for age, sex, education level, BMI, physical activity, comorbidity, medication use, and supplement consumption.

hs-CRP, high-sensitivity C-reactive protein; DH, duration of hospitalization.

P<0.05 was considered statistically significant. P-values from 0.05 to 0.07 were considered marginally significant.

Table 3. Associations between ferritin and hs-CRP levels and the odds ratio for symptoms in patients with coronavirus disease 2019 (n=107)

Data were obtained from binary logistic regression. Absence of symptoms, including chest pain, headache, nasal issues, vomiting, nausea, diarrhea, sore throat, joint pain, stomachache, confusion, contusion, fever, chills, and RDS, was considered the reference group. Ferritin and hs-CRP levels lower than median were considered the reference group. Model 1 was adjusted for age, sex, education level, body mass index (BMI), and physical activity. Model 2 was adjusted for age, sex, education level, BMI, physical activity, comorbidity, medication use, and supplement consumption.

hs-CRP, high-sensitivity C-reactive protein; RDS, respiratory distress syndrome.

P<0.05 was considered statistically significant. P-values of 0.05–0.07 were considered marginally significant.

Table 1.

Table 2.

Table 3.

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