Background. The role of liver function tests (LFT) as prognostic factors in patients admitted with COVID-19 has not been fully investigated, particularly outside resource-rich countries. We aimed at evaluating the prognostic value of abnormal LFT on admission and during hospitalization of patients with COVID-19. Methods. We performed a retrospective study that included 298 adult patients hospitalized for COVID-19, between 05/2020 and 02/2021, in 6 hospitals from 5 countries in South America. We analyzed demographic and comorbid variables and laboratory tests on admission and during hospitalization. LFT over twice the upper limit of normal (ALEx2) were also evaluated in relation to a variety of factors on admission and during hospitalization. De novo-ALEx2 was defined as the presence of ALEx2 at one week of hospitalization in patients without ALEx2 on admission. Patients were followed until hospital discharge or death. Multivariable analysis was used to evaluate the association between ALEx2 on admission and during hospitalization and mortality. Results. Of the total of 298 patients, 60% were male, with a mean age of 60 years, and 74% of patients had at least one comorbidity. Of those, 137 (46%) patients were transferred to the intensive care unit and 66 (22.1%) patients died during hospitalization. ALEx2 on admission was present in 87 (29.2%) patients and was found to be independently associated with 1-week mortality (odds ratio (OR) = 3.55; 95% confidence interval (95%CI) 1.05–12.05). Moreover, 84 (39.8%) out of 211 patients without ALEx2 at admission developed de novo-ALEx2, which was independently associated with mortality during second week of hospitalization (OR = 6.09; 95%CI 1.28–29) and overall mortality (OR = 2.93, 95%CI 1.05–8.19). Conclusions. A moderate elevation of LFT during admission was associated with a poor short-term prognosis in patients hospitalized with COVID-19. In addition, moderate elevation of LFT at one week of hospitalization was an independent risk factor for overall mortality in these patients.

Introducción: El síndrome de embolia grasa es una complicación infrecuente potencialmente fulminante que se observa en pacientes  politraumatizados .  La presencia  de glóbulos de grasa en la circulación pulmonar, da  como resultado un cuadro  rápidamente progresivo, que puede llevar a la pérdida del conocimiento  o insuficiencia respiratoria aguda, incluso  al síndrome de dificultad respiratoria del adulto (SDRA). En la radiografía pulmonar se aprecia un patrón difuso similar a la nieve, como resultado del edema pulmonar intersticial típico. El tratamiento es principalmente de soporte.  Presentación del caso: Describimos  un caso infrecuente de un paciente masculino de 24  años, sin antecedentes médicos, que fue intervenido en 2 ocasiones con fijación interna y colocación de clavo intramedular en peroné y tibia derecha respectivamente, 26 horas posteriores a la primera intervención presenta hipoxemia severa, sin afectación neurológica, e ingresó a nuestra unidad de cuidados intensivos (UCI),   se descartó tromboembolia pulmonar, etiología infecciosa y cardiogénica , la  tomografía y radiografía de tórax  evidenció : infiltrados difusos bilaterales compatible con embolia grasa. Se dio tratamiento de soporte con adecuada resolución. Conclusiones: El  síndrome de dificultad respiratoria del adulto  (SDRA) por embolia  grasa constituye un desafío diagnóstico, el reconocimiento rápido es importante para que la terapia de apoyo pueda instituirse tempranamente.