Acute Pancreatitis Appears to Be Presenting Symptom of COVID-19

One of the challenges for pharmacists and other healthcare professionals is understanding which symptoms suggest the possibility of COVID-19 infection and which do not. Now, a new study suggests that acute pancreatitis of unknown origin appears to be more common and also riskier in patients with novel coronavirus. Here are more details.

NEW HYDE PARK, NY – Could acute pancreatitis be the latest presenting symptom of the novel coronavirus?

A new journal pre-proof published in Gastroenterology suggests that symptom has been reported in up to 25% of patients. Northwell COVID-19 Research Consortium-led authors not that most patients present with respiratory symptoms, but some have shown acute pancreatitis as the initial presentation in patients with COVID-19.

Background information in the study points out that islet cells of the pancreas contain ACE2 receptor proteins and that SARS-CoV2 can bind to these receptors and cause pancreatic injury.

“Our study aimed to report the point prevalence, risk factors, and outcomes of hospitalized patients with COVID-19 presenting with acute pancreatitis in a large health system and to compare outcomes of pancreatitis in patients without COVID-19,” the authors write.

The retrospective observational cohort study involved adult patients admitted to 12 hospitals within the Northwell Health System from March 1, 2020-June 1, 2020 during the COVID-19 pandemic in New York. Over the study period, 48,012 patients were hospitalized and 11,883 of those, 24.75%, were COVID-19 positive on admission.

Acute pancreatitis was diagnosed if patients presented with all three of the following criteria:

1) lipase greater than three times the upper limit of normal,

2) cross sectional imaging (computed tomography or magnetic resonance imaging) showing pancreatitis, and

3) characteristic upper abdominal pain at admission.

With 189 participants meeting criteria for a diagnosis of pancreatitis (point prevalence 0.39%), and 32 also being COVID-19 positive, the point prevalence was 0.27% of pancreatitis among patients hospitalized with COVID-19, according to the report.

Patients with both acute pancreatitis and COVID-19 were compared to a group of patients with acute pancreatitis but without COVID-19. Researchers manually reviewed patient charts to both confirm the diagnosis of pancreatitis and to determine its etiology. Defined as the primary outcomes were mortality, length of stay, need for mechanical ventilation, and development of pancreatic necrosis, and those were compared between the two groups.

Results indicate the Charlson comorbidity index (CCI) and bedside index of severity in acute pancreatitis (BISAP) scores were equivalent between both groups. A higher proportion of Black and Hispanics had pancreatitis in the COVID positive group, however, compared to the COVID negative group (p=0.03).

The study team determined that, among the group of patients who were COVID-19 negative, gallstone and alcohol etiologies were most common at 34% and 37% respectively, similar to that of the general population. Yet, the researchers point out, among patients with COVID-19, “these etiologies only accounted for 16% and 6% of cases, respectively. Rather, idiopathic pancreatitis was the most common etiology “

“It has become increasingly clear that COVID-19 has systemic effects that also includes the gastrointestinal and pancreaticobiliary systems,” the authors write, adding that length of stay and need for mechanical ventilation was higher in patients with pancreatitis who were also COVID-19 positive compared to those without COVID-19.

They urge that pancreatitis should be included in the list of GI manifestations of COVID-19, adding, “Greater attention should be paid to the history or complaint of abdominal pain and obtaining serum lipase levels in these patients should be considered.”

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