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

Bircakova, Bianka; Brůha, Radan; Lambert, Lukáš; Grusová, Gabriela; Michálek, Pavel; Burgetová, Andrea

doi:10.1080/00365521.2021.1922751

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…Pancreatic injury from COVID19 has been explained by the expression of angiotensin-converting enzyme 2 (a target receptor for COVID19) in pancreatic islet cells [ 13 ]. Apart from the direct cytopathogenic effect of COVID-19, a systemic inflammatory response, drug-related pancreatic injury, or secondary immune-mediated inflammatory response has been suggested in its pathogenesis [ 3 , 9 , 14 ]. Whilst the link between COVID-19, hypercoagulability, and venous thromboembolism has been firmly established, splanchnic thrombosis has not been indicated in the pathogenesis of pancreatic injury [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Injury in Patients with SARS-Cov-2 (COVID-19) Infection: A Retrospective Analysis of CT Findings

Grusová

Brůha

Bircakova

et al. 2021

Gastroenterology Research and Practice

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Objective. To determine the association between COVID-19 infection and peripancreatic changes on CT as a sign of acute pancreatic injury. Methods. Retrospective analysis of CT examinations in patients with confirmed COVID-19 infection yielded 103 instances. An age- and gender-matched cohort of patients without COVID-19 was found. CT examinations were evaluated for peripancreatic stranding or edema, fluid collection, or necrosis, without any other explanation. Depicted pulmonary parenchyma was evaluated for possible COVID-19-related changes. Clinical and laboratory data were retrieved from the clinical database. Results. Peripancreatic fat stranding ( n = 8 ) or fluid collection ( n = 2 ) without any other cause was found in 10 (10%) patients. Abdominal complaints were reported in 4 (40%) patients. Elevated serum amylase or lipase levels were documented in 5 (50%) patients who also satisfied the diagnostic criteria for acute pancreatitis. From the study sample of 103 patients with COVID-19, pulmonary parenchyma was depicted in 102 (99%), and from these, 57 (55%) had an evidence of pulmonary changes compatible with COVID-19 pneumonia. This proportion was not significantly different between patients with and without peripancreatic changes ( p = 0.35 ). In the matched cohort, we found peripancreatic changes in 2 (2%, p = 0.033 ) patients. Patients with pancreatic injury and elevated amylase levels were more likely to require orotracheal intubation (35% vs. 12%, p = 0.021 ). Conclusions. We showed that the prevalence of peripancreatic stranding or fluid collection is higher in patients diagnosed with COVID-19 infection compared to an age- and gender-matched cohort. Patients with pancreatic injury and elevated amylase levels are more likely to require orotracheal intubation. Our findings corroborate the link between COVID-19 infection and pancreatic injury from the perspective of imaging.

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Section: Discussionmentioning

confidence: 99%

Pancreatic Injury in Patients with SARS-Cov-2 (COVID-19) Infection: A Retrospective Analysis of CT Findings

Grusová

Brůha

Bircakova

et al. 2021

Gastroenterology Research and Practice

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“…The VigiBase also records more than 150 pancreatitis post-vaccination reports, and this event was also reported as self-resolving uncomplicated acute pancreatitis [ 101 ]. However, COVID-19 extrapulmonary manifestations include pancreatitis even as a first symptom, whereas the bi-modal pattern of symptom onset supports both the cytotoxic and immune-related pathophysiology of pancreatic damage [ 102 ].…”

Section: Mrna Vaccination Against Covid-19 and Diagnosis Of Spontaneo...mentioning

confidence: 99%

Current Evidence in SARS-CoV-2 mRNA Vaccines and Post-Vaccination Adverse Reports: Knowns and Unknowns

Mouliou

Dardiotis

2022

Diagnostics

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The novel mRNA vaccinations against COVID-19 are gaining worldwide attention for their efficacy, as well as the diagnosis of some post-vaccination-reported adverse reactions. In this state-of-the-art review article, we present the current evidence regarding mainly the diagnosis of spontaneous allergic reactions, the skin occurrences, the vascular, blood, endocrine and heart events, the respiratory reports, the gastrointestinal, hepatic and kidney events, the reproductive and pregnancy issues and the muscle events, as well as the ear, eye, neurologic and psychiatric events following mRNA vaccination against COVID-19. We further present some evidence regarding the mRNA strategies and we discuss our expert opinion on the knowns and the unknowns towards the topic.

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“…GI involvement is likely mediated by the expression of ACE2 receptors on the GI tract which are the main receptors of SARS-CoV-2 [ 1 , 2 ]. The pancreas also expresses ACE2 receptors and hence is a potential target for SARS-CoV-2 [ 55 ]. Pancreatic injury in COVID-19 infection might occur by the direct cytotoxic effect of the virus through the ACE2 receptors on the pancreatic cells or by the COVID-19 infection-induced cytokine storm causing multiorgan dysfunction, including pancreatic injury [ 13 , 14 ].…”

Section: Reviewmentioning

confidence: 99%

Acute Pancreatitis Related to COVID-19 Infection: A Systematic Review and Analysis of Data

Aziz¹,

Aziz²,

Saleem³

et al. 2022

Cureus

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There is increasing literature mentioning severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19 infection) causing acute pancreatitis (AP). It is hypothesized that SARS-Cov-2 causes pancreatic injury either by direct cytotoxic effect of the virus on pancreatic cells through the angiotensin-converting enzyme 2 (ACE2) receptors - the main receptors for the virus located on pancreatic cells - or by the cytokine storm that results from COVID-19 infection or a component of both. Many viruses are related to AP including mumps, coxsackievirus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and as data evolves SARS-CoV-2 virus may be one of them as well. We conducted a systematic literature review to explore the current literature and provide an overview of the evidence of AP in COVID-19 infection. We studied the presence of AP in patients with SARS-CoV-2 infection and calculated the time of diagnosis of SARS-CoV-2 infection with respect to the time of diagnosis of AP. We also studied the age, gender, clinical manifestations, time of onset of symptoms, laboratory values, imaging findings, mortality, length of stay, comorbidities, need for Intensive Care Unit (ICU) care, and excluded any other common causes of AP. We included 40 articles comprising 46 patients. All patients had a positive SARS-CoV-2 polymerase chain reaction (PCR) test and all patients had AP as per Atlanta’s criteria. The most common clinical presentation was abdominal pain in 29 (63.0%). Edematous pancreas was the most common Computed Tomography Abdomen Pelvis (CTAP) scan finding in these patients (35 patients). Seventeen (37%) patients required ICU admission and six (13%) patients died. Our study provides an important overview of the available data on AP in COVID-19 patients and concludes that AP is an important complication in COVID-19 infection and should be considered as an important differential in patients with COVID-19 infection who complain of abdominal pain.

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

Cited by 9 publications

References 17 publications

Pancreatic Injury in Patients with SARS-Cov-2 (COVID-19) Infection: A Retrospective Analysis of CT Findings

Pancreatic Injury in Patients with SARS-Cov-2 (COVID-19) Infection: A Retrospective Analysis of CT Findings

Current Evidence in SARS-CoV-2 mRNA Vaccines and Post-Vaccination Adverse Reports: Knowns and Unknowns

Acute Pancreatitis Related to COVID-19 Infection: A Systematic Review and Analysis of Data

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