麻豆传媒

COVID-19 patients can present with acute pancreatitis, often of idiopathic origin, and Black and Hispanic patients with pancreatitis were more likely than others to have the infection, according to a retrospective study in a New York health system.

A total of 17% of pancreatitis patients in the analysis were positive for COVID-19, indicating that pancreatitis should be included in the list of gastrointestinal (GI) manifestations of this viral infection, said Arvind J. Trindade, MD, of the Zucker School of Medicine at Hofstra/Northwell Health System in New Hyde Park, New York.

"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 team wrote in the study online in .

Although previous case reports supported this the overall low prevalence of pancreatitis compared with other GI manifestations made the situation unclear. But since pancreatic islet cells contain SARS-CoV-2 can bind to these receptors and cause pancreatic injury.

"Physicians should be screening for upper-abdominal pain, and if present, order tests for serum lipase levels," and they should also be aware that Black and Hispanics with acute pancreatitis are more apt to have COVID-19, Trindade told 麻豆传媒.

Some research has reported GI symptoms in more than .

The current study, conducted through the Feinstein Institutes for Medical Research, reviewed the cases of patients age 18 or older admitted to 12 hospitals within the Northwell Health System in New York City, Long Island, and Westchester, New York, from March 1 to June 1, 2020. Patients with both acute pancreatitis and COVID-19 were compared with those with just acute pancreatitis.

The primary outcomes were comparative mortality, length of stay, need for mechanical ventilation, and development of pancreatic necrosis.

Of 48,012 hospitalized patients, 11,883 (24.75%) were positive for COVID-19 on admission. A total of 189 met the criteria for a diagnosis of pancreatitis (point prevalence 0.39%), and 32 of the 189 (17%) were COVID-19 positive, yielding a point prevalence of 0.27% of pancreatitis among patients hospitalized with COVID-19.

The mean ages in the negative and positive groups were 52.14 and 53.44, respectively, and 61.15% and 56.25% were female. While 50.32% in the infection-negative group were Caucasian, only 31.25% were Caucasian in the infection-positive group.

The Charlson comorbidity index and bedside index of severity in acute pancreatitis scores were equivalent in both groups (P=0.03), the researchers reported.

In the COVID-19–negative group, gallstone and alcohol etiologies were most common, at 34% and 37%, respectively, similar to the rates in the general population. Among patients with COVID-19, however, these causes accounted only for 16% and 6% of cases, respectively. Instead, idiopathic pancreatitis was the most common etiology in this group at 69% vs 21% in patients who were COVID-19–negative (P<0.0001).

After the researchers controlled for clinical relevant factors in adjusted multivariate analysis, Black and Hispanic race/ethnicity remained significantly associated with COVID-19 (odds ratios 4.48, P=0.01; and 5.07, P=0.006, respectively).

Additionally, pancreatitis patients with COVID-19 were more likely to require mechanical ventilation (28.13% vs 6.37%) and to have longer hospital stays than those without COVID-19 (OR 5.65, P=0.01; and OR 3.22, P=0.009, respectively). Those with COVID-19 were also more likely to develop pancreatic necrosis (12.5% vs 4.46%), the investigators said.

Although necrosis and mortality followed similar trends, these associations were not statistically significant, the researchers added.

Asked for his perspective, Mohamed Othman, MD, of Baylor St. Luke's Medical Center in Houston, who was not involved with the study, noted that acute pancreatitis has been previously associated with other viral infections such as mumps, herpes simplex, and cytomegalovirus. "It appears SARS-CoV-2 is no exception," he told 麻豆传媒.

"The virus is associated with a transient acute pancreatitis attack similar to other infectious agents. Luckily, acute pancreatitis in these settings resolves with no residual complications in the majority of patients," he noted.

Othman added, however, that about a third of patients in the SARS-CoV-2 group in the study had severe acute pancreatitis, and 12.5% of patients developed pancreatic necrosis: "That could result in permanent damage in the pancreas with the possibility of long-term endocrine and exocrine insufficiency," he explained.

Trindade and co-authors noted that their study was the largest series of its kind to date, and called for further large studies to confirm the findings.

Study limitations, the researchers said, included its retrospective nature and that at just 32, the number of patients with both pancreatitis and COVID-19 was relatively low. In addition, the inclusion of all three defining criteria for pancreatitis diagnosis (rather than the usual two needed for diagnosis) may have led to underestimation of the rate of pancreatitis.

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