Acute pancreatitis, SARS-CoV-2 increase risk for disease severity
Patients with coexistent acute pancreatitis and SARS-CoV-2 infection had an increased risk for severe acute pancreatitis and worse clinical outcomes, according to study results.
Manu Nayar, MD, from Freeman Hospital in Newcastle, United Kingdom, and colleagues wrote that new data suggest that the gastrointestinal tract and the pancreas appear to be target organs for SARS-CoV-2 because of the expression of the ACE2 receptor there.
“It has also been postulated that infection leads to increased expression and distribution of ACE2, particularly on the pancreatic islet cell, increasing the risk of pancreatic injury and hyperglycemic,” they wrote. “It is however unknown if SARS-CoV-2 infection causes pancreatic injury and acute pancreatitis or cause an aggravated inflammatory response, and increased risk of organ failure and pancreatic complications leading to increased patient morbidity and mortality.”
Researchers investigated the outcomes of patients with acute pancreatitis (AP) and SARS-CoV-2 in a prospective cohort study. The primary outcome of the study was severity of AP. Investigators also assessed ICU admission, length of hospital stay, 30-day mortality and other outcomes.
The study included 1,777 patients with AP from March 1 to July 23, 2020. From that group, 149 patients had concomitant SARS-CoV-2 infection.
Patients with AP and SARS-CoV-2 were more likely to develop severe AP and acute respiratory distress syndrome (P < .001).
In an unadjusted analysis, Nayar and colleagues found that patients with SARS-CoV-2 infection and AP were more likely to need ICU admission (OR = 5.21; P < .001), have local complications (OR = 2.91; P < .001), persistent organ failure (OR = 7.32; P < .001), prolonged hospital stay (OR = 1.89; P < .001) and a higher 30-day mortality (OR = 6.56; P < .001) than patients with AP alone.
In an adjusted analysis, researchers found that that length of stay (OR = 1.32; P < .001), persistent organ failure (OR = 2.77; P < .003) and 30-day mortality (OR = 2.41; P < .04) were significantly higher among patients with SARS-CoV-2 co-infection.
“These findings have implications for management of patients with acute pancreatitis during the current pandemic,” Nayar and colleagues wrote. “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.”