RESUMO

INTRODUCTION: Bile acids are signaling molecules with immune, metabolic and intestinal microbiota control actions. In high serum concentrations they increase inflammatory response from the liver-gut axis, until causing multiorgan failure and death; therefore, they may be associated with COVID-19's clinical progression, as a consequence of tissue and metabolic damage caused by SARS-CoV-2. While this topic is of considerable clinical interest, to our knowledge, it has not been studied in Cuba. OBJECTIVE: Study and preliminarily characterize patients admitted with a diagnosis of COVID-19 and high levels of serum bile acids. METHODS: A preliminary exploratory study was carried out with descriptive statistical techniques in 28 COVID-19 patients (17 women, 11 men; aged 19-92 years) who exhibited high levels of serum bile acids (≥10.1 µmol/L) on admission to the Dr. Luis Díaz Soto Central Military Hospital in Havana, Cuba, from September through November 2021. RESULTS: On admission patients presented hypocholesterolemia (13/28; 46.4%), hyperglycemia (12/28; 43.0%) and hyper gamma-glutamyl transpeptidase (23/28; 84.2%). Median blood glucose (5.8 mmol/L) and cholesterol (4.1 mmol/L) were within normal ranges (3.2‒6.2 mmol/L and 3.9‒5.2 mmol/L, respectively). Severe or critical stage was the most frequent (13/28) and median serum bile acids (31.6 µmol/L) and gamma-glutamyl transferase (108.6 U/L) averaged well above their respective normal ranges (serum bile acids: 0‒10 µmol/L; GGT: 9‒36 U/L). Arterial hypertension was the most frequent comorbidity (19/28; 67.9%). CONCLUSIONS: Severe or critical stage predominated, with serum bile acids and gamma-glutamyl transferase blood levels above normal ranges. The study suggests that serum bile acid is toxic at levels ≥10.1 µmol/L, and at such levels is involved in the inflammatory process and in progression to severe and critical clinical stages of the disease. In turn, this indicates the importance of monitoring bile acid homeostasis in hospitalized COVID-19 patients and including control of its toxicity in treatment protocols.

Assuntos

Ácidos e Sais Biliares , COVID-19 , Feminino , Humanos , Masculino , Ácidos e Sais Biliares/sangue , COVID-19/sangue , COVID-19/diagnóstico , Cuba/epidemiologia , Hospitais , SARS-CoV-2 , Transferases , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais

RESUMO

La Ectasia Vascular Gástrica Antral es una rara causa de sangrado digestivo alto y la ablación con argón plasma resulta la primera línea de tratamiento actual. El objetivo de este trabajo consiste en analizar la efectividad y seguridad del APC en el tratamiento de este síndrome, en pacientes atendidos en el Centro Nacional de Cirugía de Mínimo Acceso. Se presenta una casuística retrospectiva de 11 pacientes, con predominio femenino (8 pacientes) y rango de edades entre 28 y 81 años, quienes recibieron ablación con APC por sesiones, con seguimiento posterior de 12 meses. Predominó la cirrosis hepática entre los antecedentes patológicos personales, la anemia como forma de presentación clínica y la variedad difusa. El número de sesiones de argón osciló entre 1 y 4 con promedio de 2.5, con una recidiva durante el seguimiento y no se presentaron complicaciones mayores secundarias a la terapia endoscópica.

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Gastric Antral Vascular Ectasia is a rare cause of upper gastrointestinal bleeding and Argon Plasma ablation is its current first line treatment. The aim of this paper is to analyze the effectiveness and safety of argon plasma coagulation in the treatment of this syndrome in a sample of patients treated at the National Center for Minimal Access Surgery. We present a retrospective series of cases of 11 patients with female predominance (8 patients) and age range between 28 and 81 years who received APC ablations sessions with subsequent follow up within 12 months. Hepatic cirrhosis predominated among the personal pathological antecedents, anemia was the most common clinical presentation followed by a wide variety of symptoms. The number of sessions with argon fluctuated between one and four for a 2.5 average and with recurrence during the follow up period. There were not major secondary complications to endoscopy therapy.