COVID-19 Compounds Risks for Patients With Acute Pancreatitis

By Matthew Phelan

March 17, 2021

NEW YORK (Reuters Health) - Patients suffering from acute pancreatitis (AP) who also contract COVID-19 risk longer hospital stays, persistent organ failure, and a higher likelihood of early death, compared with patients without the virus, according to a continent-spanning new report.

"This is one of the few studies that has actually shown a difference in outcomes," Dr. Sumant Inamdar, a gastroenterologist at the University of Arkansas for Medical Sciences, in Little Rock, told Reuters Health y phone. "Hospitalizations are higher. ICU stay is longer."

Dr. Inamdar, who did not participate in the study, noted that its multicenter approach -- incorporating patient data from England, Wales, Scotland, Northern Ireland, Malta, Italy, Pakistan, Turkey and Lithuania -- significantly helped bolster its findings.

"We had a few U.S. studies and a couple of them were from China initially," said Dr. Inamdar, "but from the European side there hasn't been much literature on pancreatitis and COVID."

For the study, published in Gut, researchers invited all hospitals in the U.K. and globally that were admitting patients with acute pancreatitis to contribute data to a database held and monitored at the Newcastle Joint Research Office, in Newcastle upon Tyne, U.K.

Between March and July 23, 2020, 1,777 patients with acute pancreatitis were included. On average, the 149 (8.3%) patients who were diagnosed with COVID-19 were older, more often male and more likely to present evidence of severe acute pancreatitis and acute respiratory distress syndrome. No significant differences in ethnicity were found.

Gallstones were the most common etiology for AP in both groups, while an alcohol-based etiology was significantly more common in the COVID-negative group (27% vs. 19%).

After adjusting for factors like age, sex, smoking and drinking habits, aetiology, Eastern Cooperative Oncology Group (ECOG) score, and severity of AP, COVID-positive patients had longer hospital stays (odds ratio, 1.32; P<0.001), more persistent organ failure (OR, 2.77; P<0.003) and higher 30-day mortality (OR, 2.41; P<0.04).

In the unadjusted analysis, these patients also had significantly higher risks of being admitted to the intensive-care unit (ICU) and developing local complications near the pancreas.

Lead author Dr. Manu Nayar of Freeman Hospital, in Newcastle upon Tyne email, told Reuters Health by email that, in his personal experience and despite the uncertainty around these latter results, "ICU admission and peripancreatic fluid collections would be outcomes that medical professionals would want to bear in mind when looking after this group of patients."

The cause of AP was unknown in a quarter of the cases in the COVID-positive group vs. 19% of the COVID-negative group (P=0.08).

"In the present series, the majority of patients with concomitant AP and SARS-CoV-2 infection, especially in those with a SARS-CoV-2 infection conformed on a positive swab with 14 days of admission presented with hyperamylasaemia in support of the hypothesis that SARS-Cov-2 may cause pancreatic injury and pancreatitis," the researches write. "However, this association can only be substantiated by use of a pancreas organoid model to study the pancreas-specific effects of SARS-CoV-2."

Dr. Inamdar also expressed interest in this particular question. He noted that, while several other viral infections such as Coxsackie B, mumps, and hepatitis, are believed to cause AP, severe COVID-19 cases could present with findings that only superficially resemble AP.

"You have a group of patients who have quite severe Covid disease and they leak their enzymes - that can appear like pancreatitis, but on a CAT scan the pancreas actually looks fine," he said. "So, that might actually not be true pancreatitis but just severe Covid causing overall, multiple organ damage."

"But if COVID is one of the underlying causes for pancreatitis then that's something that people need to keep in mind," Dr. Inamdar added.

SOURCE: Gut, online February 5, 2021.