Patients with acute pancreatitis (AP) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay, and high 30-day mortality, according to a study in Gut.
This prospective, international, multicenter study included consecutive patients admitted with AP during the coronavirus disease 2019 (COVID-19) pandemic. AP severity was the primary outcome measure, and secondary outcomes included AP etiology, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure, and 30-day mortality.
A total of 1777 patients with AP were initially included during the study period from March 1, 2020 to July 23, 2020. Of this cohort, 149 patients (8.3%) (mean age, 59.9 ± 17.2 years; 62.8% male; and 85.3% white, for whom data were available) became infected with SARS-CoV-2.
The severity of AP was significantly worse among SARS-CoV-2–positive patients, as 22.6% of this group developed severe pancreatitis, compared with 6.3% of patients who were negative for SARS-CoV-2 (P <.001). ARDS was also significantly higher in the SARS-CoV-2–positive group (13.6% vs 4%; P <.001).
Among patients who had a positive SARS-CoV-2 swab within 14 days of admission, along with hyperamylasemia, 49% (43/88) developed moderate to severe or severe pancreatitis.
A total of 1483 patients (1373 negative and 110 positive for SARS-CoV-2) were included in the analysis that compared outcomes for patients who were positive and negative for SARS-CoV-2.
The overall 30-day mortality rate among patients positive for SARS-CoV-2 was 14.7%, compared with 2.6% in those who were negative for the virus (P <.04).
According to unadjusted analyses, patients with concomitant SARS-CoV-2 infection and AP were more likely to require ICU admission (odds ratio [OR], 5.21; 95% CI, 3.06-8.85) and have acute pancreatic fluid collections (OR, 3.33; 95% CI, 2.15-5.16), pancreatic necrosis (OR, 2.35; 95% CI, 1.41-3.90), local complications (OR, 2.91; 95% CI, 1.89-4.49), persistent organ failure (OR, 7.32; 95% CI, 4.48-12.0), prolonged length of hospital stay (OR, 1.89; 95% CI, 1.64-2.19), and increased 30-day mortality (OR, 6.56; 95% CI, 3.44-12.5).
After adjusting for potential confounding variables, the investigators found that 30-day mortality was higher in the SARS-CoV-2–positive group (OR, 2.4; 95% CI, 3.44-12.5), compared with the SARS-CoV-2–negative group. In addition, length of hospital stay (OR, 1.32; 95% CI, 3.44-12.5) and persistent organ failure (OR, 2.77; 95% CI, 1.43-5.39) were worse in patients who were positive for SARS-CoV-2.
The researchers noted certain limitations to their findings, including the varying testing protocols that were used. Additionally, in the early phase of the pandemic, routine testing was not available to diagnose patients with SARS-CoV-2. Thus, poor test sensitivity may have allowed a small number of patients who were presumed negative for SARS-CoV-2 infection to be included in the group of patients with acute pancreatitis with no SARS-CoV-2 infection.
“These findings have implications for management of patients with acute pancreatitis during the current pandemic,” the study authors commented. “If the infection continues to be prevalent without an effective treatment or vaccine, these data help clinicians to better prognosticate for patients with concomitant AP and SARS-CoV-2 infection and optimize resource allocation.”
Pandanaboyana S, Moir J, Leeds JS, et al. SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study. Gut. Published online February 5, 2021. doi: 10.1136/gutjnl-2020-323364