Elevación de los niveles de transaminasas y bilirrubina total como marcadores pronósticos de mortalidad en adultos hospitalizados por COVID-19. Un estudio de cohorte

Autores/as

  • Andrés Fernando Rodríguez-Gutiérrez Universidad Nacional de Colombia, Universidad de los Andes, Hospital Universitario Nacional de Colombia. https://orcid.org/0000-0002-3909-4230
  • Camilo Andrés Duarte-Calderón Universidad Nacional de Colombia. https://orcid.org/0009-0007-3535-8773
  • Sergio Mauricio Moreno López Universidad de los Andes.

DOI:

https://doi.org/10.52787/agl.v54i1.390

Palabras clave:

COVID-19, mortalidad, pruebas de función hepática, transaminasas, bilirrubina, pronóstico

Resumen

Introducción. El hígado es un órgano que se ve afectado por múltiples mecanismos en presencia de COVID-19. El objetivo de este estudio fue determinar si los niveles elevados de alanina aminotransferasa, aspartato aminotransferasa y bilirrubina total son predictores de mortalidad en adultos con COVID-19.

Materiales y métodos. Estudio de cohorte retrospectivo de adultos hospitalizados entre 2020 y 2022 en un hospital universitario de Bogotá por COVID-19 e hipoxemia. La mortalidad por todas las causas fue el resultado primario. Y se construyó un modelo multivariado independiente para cada uno de los siguientes marcadores de lesión hepática: alanina aminotransferasa, aspartato aminotransferasa y bilirrubina total. Cada modelo se ajustó por edad, presencia de diabetes mellitus, presencia de fiebre durante la hospitalización, recuento de linfocitos, dímero D y lactato deshidrogenasa.

Resultados. Se incluyó a un total de 704 pacientes. La tasa de mortalidad fue del 38%. Los niveles elevados de alanina aminotransferasa, aspartato aminotransferasa y bilirrubina total al ingreso se registraron en el 64%, 64% y 8,3% de los pacientes, respectivamente. Según el análisis multivariado, la elevación de los niveles de aspartato aminotrasferasa (OR = 1.06; IC 95%: 1.02 - 1.11 por cada aumento de 40 U/L, valor de p = 0.009) y de bilirrubina total (OR = 1.26, IC 95%: 1.08 -1.47 por cada aumento de 1mg/dl, valor de p = 0.003) se asociaron de forma independiente con la muerte. El nivel de bilirrubina total también se asoció con el ingreso en la unidad de cuidados intensivos, la necesidad de ventilación mecánica invasiva y la duración de la estancia hospitalaria. Los resultados de la alanina aminotransferasa no permitieron concluir una asociación independiente con la muerte. La edad, la fiebre y el recuento más bajo de linfocitos durante la hospitalización también se asociaron con la muerte.

Conclusión. Los niveles elevados de transaminasas y bilirrubina total son hallazgos frecuentes en pacientes con COVID-19 e hipoxemia. La aspartato aminotransferasa y la bilirrubina total fueron predictoras de mortalidad en estos pacientes, por lo que su medición al ingreso es una práctica razonable. Es necesario avanzar en la incorporación de estos marcadores en modelos predictivos de mortalidad y en reglas de decisión clínica.

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Publicado

2024-03-25

Cómo citar

Rodríguez-Gutiérrez, A. F., Duarte-Calderón, C. A., & Moreno López, S. M. (2024). Elevación de los niveles de transaminasas y bilirrubina total como marcadores pronósticos de mortalidad en adultos hospitalizados por COVID-19. Un estudio de cohorte. Acta Gastroenterológica Latinoamericana, 54(1), 42–55. https://doi.org/10.52787/agl.v54i1.390