COVID-19: Acute Pancreatitis a Possible Symptom of Infection

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COVID-19 has systemic effects that include the gastrointestinal and pancreaticobiliary systems.

Acute pancreatitis should be included among possible gastrointestinal manifestations of coronavirus disease 2019 (COVID-19), according to research results published in Gastroenterology.

Researchers examined patients admitted into hospitals with acute pancreatitis within the Northwell Health System from March 1 to June 1, 2020. An acute pancreatitis diagnosis was confirmed by the presence of lipase greater than 3 times the upper limit of a normal count, computed tomography- or magnetic resonance imaging-confirmed pancreatitis, as well as upper abdominal pain at the time of admission into the hospital. Inclusion criteria also required patients to be aged ≥18 years. A total of 189 patients met pancreatitis diagnosis criteria, and 32 of those patients also had COVID-19.

Investigators assessed need for ventilation, the length of patient hospital stays, the development of pancreatic necrosis, and patient mortality. Researchers found that patients with both pancreatitis and COVID-19 were more likely to require mechanical ventilation and to have longer hospital stays than patients with pancreatitis and no COVID-19 diagnosis (odds ratio [OR] 5.65; P =.01 and OR 3.22; P =.009, respectively). Black and Hispanic patients with pancreatitis were more likely to be diagnosed with COVID-19 (OR 4.48; P =.01 and OR 5.07; P =.006). Researchers noted that “mortality and development of pancreatic necrosis followed similar trends but were not statistically significant.”

Study limitations include those inherent to retrospective studies; however, the report has notable strengths including the generalizability of the results based on the diversity of the population studied, a standardized accepted definition of pancreatitis, the usage of data from a large health system, and the manual nature of the chart review process.

Other limitations included the usage of all 3 criteria for a pancreatitis diagnosis, whereas 2 out of 3 criteria are typically required. Furthermore, the number of patients with both acute pancreatitis and COVID-19 was relatively low.

“These findings support the notion that pancreatitis should be included in the list of [gastrointestinal] manifestations of COVID-19… Greater attention should be paid to the history or complaint of abdominal pain, and obtaining serum lipase levels in these patients should be considered,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Inamdar S, Benias PC, Liu Y, et al. Prevalence, risk factors, and outcomes of hospitalized patients with COVID-19 presenting as acute pancreatitis [published August 26, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.08.044