Background: The aim of this study is to determine the order frequency of serum ceruloplasmin testing, rate of positive tests, epidemiological characteristics, and outcomes of the patients with a positive ceruloplasmin. Ceruloplasmin is a serum ferroxidase that is produced by liver hepatocytes using P-type ATPase to incorporate 6 to 8 copper atoms into apo-ceruloplasmin. Ceruloplasmin is then sent to the distal sites for iron metabolism. The primary role of ceruloplasmin is that it is responsible for over 90% of copper transport in the body. Clinically, ceruloplasmin is well known to be involved in the pathogenesis of Wilson disease as well as iron metabolism derangements. In addition, ceruloplasmin is a positive acute-phase reactant that will rise in circumstances of inflammation or cell injury. The ceruloplasmin test is typically more sensitive than specific but with a low positive rate overall. However, there is little data on ceruloplasmin data and its interpretations. Today we present extensive data from a tertiary care medical center on ceruloplasmin.
Methods: We performed a retrospective observational study of all patients who received ceruloplasmin test at University of Mississippi Medical Center from Jan 1st 2013 to Dec 31st 2021. Patient Cohort Explorer was used to obtain de-identified patient data from EPIC. We obtained multiple variables of patients on whom serum ceruloplasmin testing was performed. Further analysis was performed on the de-identified data to study the epidemiology of ceruloplasmin testing using Microsoft excel.
Results: Serum Ceruloplasmin level was ordered 1491 times on 1483 patients over 1382 hospital encounters. 104, 174, 163, 161, 140, 158, 201, 215, 173 tests were done annually from 2013 to 2021. 698 tests were done in females and 791 in males. About 582 tests were done in African Americans and 836 tests were done in Caucasians. The median age of testing was 51 years with 686 under 50 and 764 over 50. Of the 1491 tests, 349 tests (23.41%) came back with level < 15.0 mcg/ml, the lower cut off value. 156 tests (10.46%) came back over the upper limit of >30.0 mcg/ml. 698 tests were done in females, of which 186 tests (26.64%) were low and 22 (3.15%) were elevated. 791 tests were done in males, and of which 163 tests (20.61%) were low and 134 (16.94%) were elevated. Of the 582 tests done in African Americans (AA) 107 (18.38%) were low and 84 (14.43%) were elevated. 836 tests were done in Caucasians. 224 tests (26.79%) came back low while 63 (7.54%) were elevated. At the end of study period, of the 1483 unique patients 1021 (68.44%) are alive and 468 (31.56%) deceased. Out of those deceased, 138 (29.49%) had low copper levels and 41 (8.76%) had elevated levels.
Conclusions: To our knowledge this is the largest data sample with Serum Ceruloplasmin levels in adult hospitalized patients. Interestingly close to one in 4 samples that was tested for Ceruloplasmin level was lower than the minimum cut off and about one in ten came elevated. Low ceruloplasmin levels are more prevalent in females and Caucasians compared to males and African Americans. Even though ceruloplasmin deficiency in hospitalization may not reflect ceruloplasmin deficiency in general population, it is alarming to see the prevalence ceruloplasmin deficiency in hospitalized patients. More studies are needed to see which patients are ceruloplasmin deficient and if ceruloplasmin deficiency is responsible for increased mortality and morbidity in hospitalized patients.