Análise do perfil hepático de pacientes acometidos pelo SARS-CoV-2 internados na UTI covid do Hospital Universitário de Santa Maria, RS

Abstract

SARS-CoV-2 is the causative agent of COVID-19. Although the lungs are the primary target of the virus, resulting in respiratory complications and, in extreme cases, fatality, the infection has also been associated with damage to various other organs, including the liver. Hepatic injuries caused directly or indirectly by the virus are generally assessed by measuring levels of markers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin. Studies indicate that the occurrence of hepatic impairment in COVID-19 patients ranges from 15% to 60%, depending on the studied population. Thus, this dissertation aimed to investigate the laboratory differences in the hepatic profile of severe COVID-19 patients to correlate them with clinical outcomes. It is a retrospective study that included 377 adult patients with severe COVID19 admitted to the ICU at the University Hospital of Santa Maria (HUSM) between February 2021 and February 2022. Demographic, clinical, and laboratory data, including ALT and AST levels, were collected from electronic medical records. Laboratory data were evaluated upon ICU admission and before discharge or death. Hepatic injury was classified into four grades based on AST and/or ALT levels above the upper normal limit. Descriptive statistics were calculated for demographic and clinical data, and the association between hepatic injury and mortality was assessed by multivariate Cox regression analysis. Approximately 65% of patients showed signs of hepatic impairment upon ICU admission, predominantly classified as Grade 1. Hepatic injury was significantly associated with mortality, with elevated aminotransferase levels, especially AST, as independent predictors of fatal outcomes. Survivors showed a positive trend of hepatic recovery, while progression to more severe stages of hepatic injury and older age were factors associated with worse prognosis, as indicated by Cox regression analysis. Men and women exhibited similar clinical profiles in terms of hepatic injury, but female survivors had longer ICU stays. The dynamic progression of hepatic injury highlights its prognostic significance in SARS-CoV-2 infection, necessitating continuous monitoring and timely intervention, especially for older patients.