RESUMEN : Objetivo: evaluar la utilidad de niveles elevados de cobalamina como biomarcadores de enfermedad médica. Método: estudio observacional retrospectivo de una cohorte de pacientes con niveles de B12 >1000 pg/ml. Resultados: Un total de 7.682 pacientes presentaban determinaciones de B12 y en 207 (2,7%) de estos se objetivó hipercobalaminemia. Se excluyeron 62 pacientes por administración exógena de cobalamina, seleccionando finalmente 145 pacientes que se siguieron durante 42 meses. Durante el seguimiento clínico, 52 (35,9%) pacientes fallecieron. Se detectó hepatopatía estructural en 32 (22,1%) pacientes, diagnosticándose 12 (8,3%) de ellas durante el seguimiento clínico. La esteatohepatitis no alcohólica encontrada en 13 (40,6%) pacientes y la asociada al alcohol presente en 7 (21,9%) fueron las hepatopatías más frecuentes. Se estudió específicamente la existencia de neoplasia sólida y hematológica. Encontrándose 15 (10,3%) casos de neoplasia sólida, diagnosticándose 10 (6,9%) de ellas durante el seguimiento; y se descubrió 17 (11,7%) casos de hematopatía maligna, siendo 9 (6,2%) de nuevo diagnóstico. La procedencia de atención especializada (ExpB 3,1 (IC95%1,5-6,5) fue el único factor predictor de cáncer en estos pacientes. Conclusión: La hipercobalaminemia está asociada a hepatopatías y neoplasias sólidas y hematológicas pudiendo, frecuentemente, preceder al diagnóstico de la enfermedad.

ABSTRACT : Objective: to evaluate the usefulness of elevated cobalamin levels as biomarkers of medical disease. Methods: retrospective and observational record on a patients group with B12 levels >1000 pg/ml. Results: A total of 7682 patients had B12 determinations and 207 (2.7%) of these were found to have hypercobalaminemia. Sixty-two patients were excluded due to exogenous administration of cobalamin, and 145 patients were finally selected and followed for 42 months. During clinical follow-up, 52 (35.9%) patients died. Structural liver disease was detected in 32 (22.1%) patients, 12 (8.3%) of whom were diagnosed during clinical follow-up. Non-alcoholic steatohepatitis was found in 13 (40.6%) patients and alcohol associated steatohepatitis in 7 (21.9%) being those the most frequent liver diseases. The existence of solid and haematological neoplasia was specifically studied. We found 15 (10.3%) cases of solid neoplasia, 10 (6.9%) of which were diagnosed during follow-up; and 17 (11.7%) cases of malignant haematopathy were discovered, 9 (6.2%) of which were newly diagnosed. Specialized health care origin (ExpB 3.1 (95%CI 1.5-6.5) was the only predictor of cancer in these patients. Conclusion: Hypercobalaminemia is associated with hepatopathies and solid and haematological malignancies and may frequently precede the diagnosis of the disease.

Grado en Medicina