• This record comes from PubMed

A bimodal pattern of the onset of COVID-19 related acute pancreatitis supports both the cytotoxic and immune-related pathogenesis - a systematic review

. 2021 Jul ; 56 (7) : 870-873. [epub] 20210514

Language English Country Great Britain, England Media print-electronic

Document type Journal Article, Systematic Review

OBJECTIVES: To review clinical and laboratory findings in patients with SARS-Cov-2 (COVID-19) related acute pancreatitis. METHODS: This systematic review was based on a database search for articles of COVID-19 related acute pancreatitis in adult patients with confirmed COVID-19 infection that included age, gender, presenting symptoms, the onset of symptoms, laboratory values, imaging findings and exclusion of common causes of pancreatitis. RESULTS: Altogether 35 articles comprising 37 patients were included. Acute pancreatitis was the first presentation of COVID-19 in 43% of patients, concurrent with general or respiratory symptoms in 14% of patients or delayed after general or pulmonary symptoms by an average of 10 ± 5 d (range, 1 - 19 d) in 43% of patients. Serum amylase and lipase levels were elevated in 87% and 100% of patients. In 50% and 84%, amylase and lipase levels exceeded three-fold the upper normal limit. Pancreatic necrosis was reported in 6% of patients and in 12% of patients, the pancreas appeared normal. Three patients died. CONCLUSIONS: We conclude that the bi-modal pattern of the onset of symptoms supports both the cytotoxic and the immune-related pathogenesis of the pancreatic injury. Acute pancreatitis may be the first symptom of COVID-19 infection. Necrosis of the pancreas is rare.

See more in PubMed

Liu F, Long X, Zhang B, et al. . ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection. Clin Gastroenterol Hepatol. 2020;18:2128–2130. PubMed PMC

Inamdar S, Benias PC, Liu Y, et al. . Prevalence, risk factors, and outcomes of hospitalized patients with coronavirus disease 2019 presenting as acute pancreatitis. Gastroenterology. 2020;159:2226–2228. PubMed PMC

Cheung KS, Hung IFN, Chan PPY, et al. . Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology. 2020;159:81–95. PubMed PMC

Dalan R, Bornstein SR, El-Armouche A, et al. . The ACE-2 in COVID-19: foe or Friend? Horm Metab Res. 2020;52:257–263. PubMed PMC

El-Kurdi B, Khatua B, Rood C, et al. . Mortality from coronavirus disease 2019 increases with unsaturated fat and may be reduced by early calcium and albumin supplementation. Gastroenterology. 2020;159:1015–1018. PubMed PMC

Akarsu C, Karabulut M, Aydin H, et al. . Association between acute pancreatitis and COVID-19: could pancreatitis be the missing piece of the puzzle about increased mortality rates? J Investig Surg. 2020;1–7. PubMed

Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. PubMed PMC

Banks PA, Bollen TL, Dervenis C, et al. . Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111. PubMed

Rawla P, Bandaru SS, Vellipuram AR.. Review of infectious etiology of acute pancreatitis. Gastroenterol Res. 2017;10:153–158. PubMed PMC

Spinelli A, Pellino G.. COVID‐19 pandemic: perspectives on an unfolding crisis. Br J Surg. 2020;107:785–787. PubMed PMC

Wang F, Wang H, Fan J, et al. . Pancreatic injury patterns in patients with coronavirus disease 19 pneumonia. Gastroenterology. 2020;159:367–370. PubMed PMC

Barlass U, Wiliams B, Dhana K, et al. . Marked elevation of lipase in COVID-19 disease: a cohort study. Clin Transl Gastroenterol. 2020;11(7):e00215. PubMed PMC

Pezzilli R, Centanni S, Mondoni M, et al. Patients with COVID-19 interstitial pneumonia exhibit pancreatic hyperenzymemia and not acute pancreatitis. Res Square. 2020. DOI:10.21203/rs.3.rs-50275/v1. PubMed DOI PMC

Rathi S, Sharma A, Patnaik I, et al. . Hyperlipasemia in COVID-19: statistical significance vs clinical relevance. Clin Transl Gastroenterol. 2020;11:e00261. PubMed PMC

Zippi M, Hong W, Traversa G, et al. . Involvement of the exocrine pancreas during COVID-19 infection and possible pathogenetic hypothesis: a concise review. Infez Med. 2020;28:507–515. PubMed

Meireles PA, Bessa F, Gaspar P, et al. . Acalculous acute pancreatitis in a COVID-19 patient. Eur J Case Rep. 2020;7:001710. PubMed PMC

Ye Q, Wang B, Zhang T, et al. . The mechanism and treatment of gastrointestinal symptoms in patients with COVID-19. Am J Physiol - Gastrointest Liver Physiol. 2020;319:G245–52. PubMed PMC

Wong SH, Lui RN, Sung JJ.. Covid-19 and the digestive system. J Gastroenterol Hepatol. 2020;35:744–748. PubMed

D’Amico F, Baumgart DC, Danese S, et al. . Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention, and management. Clin Gastroenterol Hepatol. 2020;18:1663–1672. PubMed PMC

Find record

Citation metrics

Loading data ...

Archiving options

Loading data ...