Iron constitutes a potentially toxic element and consequently, hepatic iron overload may accelerate liver disease progression and development of hepatocellular carcinoma (HCC). Hepcidin is the central negative regulator of iron metabolism that is produced primarily by the liver.

To study the prognostic significance of serum hepcidin, we assessed the influence of baseline serum hepcidin levels on the outcome of a French cohort encompassing 237 patients with alcoholic cirrhosis prospectively followed up in the setting of HCC screening.

Hepcidin values correlated weakly with serum ferritin levels (r = 0.33) and hepatic iron scores (r = 0.3). After a median follow‐up of 68 months, patients with baseline lower hepcidin level had a higher risk of HCC occurrence [hazard ratio, HR = 1.76 (1.01–3.06), P = 0.031] and overall death [HR = 1.63 (1.07–2.44), P = 0.019]. According to Cox multivariate analyses, lower hepcidin levels were independently associated with death [HR = 2.84 (1.29–6.25), P = 0.009] along with higher Child–Pugh score while HCC occurrence was mainly associated with clinical confounders interfering with iron metabolism (older age and higher BMI, adjusted P‐value for hepcidin = 0.119).

In conclusion, low‐serum hepcidin levels in patients with alcoholic cirrhosis bear a long‐term prognostic significance warranting further explorations.