COVID-19 With Acute Pancreatitis Increases Risk for Multiorgan Failure, Mortality

A team of investigators sought to determine the course of acute pancreatitis in patients with SARS-CoV-2 infection.

Patients with acute pancreatitis caused by coronavirus-2019 (COVID-19) were found to be at higher risk for multiorgan failure and mortality, according to the results of a retrospective analysis published in Gastroenterology.

All patients hospitalized within the MHealth Fairview System in Minnesota between March 1, 2020, and June 30, 2020, with acute pancreatitis were retrospectively included. The study had 2 cohorts: patients who had nasopharyngeal swab-confirmed COVID-19 (n=75) and those who tested negative for COVID-19 (n=264). Patients were assessed using the Bedside Index of Severity in Acute Pancreatitis (BISAP) and Charlson Comorbidity Index (CCI) to predict 10-year survival.

The cohorts were well balanced for age (P =.76), gender (P =.77), ethnicity (P =.77), and body mass index (P =.95) at baseline. However, patients with COVID-19 were found to have higher BISAP scores (BISAP ≥3, 43% vs 5%; P <.0001) and CCI scores (CCI 3-4, 35.7% vs 6.6%; P =.003). Among the COVID-19-negative cohort, a diagnosis of acute pancreatitis was more likely to be alcoholic AP, and COVID-19-positive patients were more likely to have idiopathic acute pancreatitis (P <.0001).

Mortality was observed to be higher among patients with acute pancreatitis and COVID-19 (21% vs 2%; P =.004), as were persistent organ failure (57% vs 8%; P <.0001) and multiorgan failure (renal and respiratory, 43% vs 5%; triple organ, 14% vs 0%; P <.0001).

No significant differences were observed for endocrine insufficiency (7% vs 7%; P >.99), infected necrosis (7% vs 5%; P =.74), pattern of acute pancreatitis (interstitial, 86% vs 90%; necrotizing, 14% vs 10%; P =.63), mechanical ventilation (noninvasive, 29% vs 5%; invasive, 14% vs 0%; P =.62), length of stay in the intensive care unit (3.6±4.3 vs 0.75±3.6 days; P =.35), or splanchnic venous thrombosis (14% vs 7%; P =.3) for COVID-19-positive compared with COVID-19-negative patients, respectively.

The limitations of this study include the fact that no data on inflammatory markers were recorded and that patients were treated at different hospitals, which may have introduced some bias.

The study authors concluded that patients with acute pancreatitis and COVID-19 were at increased risk for multiorgan failure and mortality compared with patients with acute pancreatitis and no COVID-19 infection. The relationship between acute pancreatitis and the severe acute respiratory syndrome coronavirus-2 is complex, and further research is needed.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

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Reference

Dirweesh A, Li Y, Trikudanathan G, Mallery JS, Freeman ML, Amateau SK. Clinical outcomes of acute pancreatitis in patients with COVID-19. Gastroenterology. Published online July 25, 2020. doi:10.1053/j.gastro.2020.07.038