Current evidence on pancreatic involvement in SARS-CoV-2 infection

Marked Elevation of Lipase in COVID-19 Disease: A Cohort Study

“…Pancreatic injury and inflammation are a well-known cause of organ failure with relapsing fever ( 15 ). Although pancreas involvement is reported in other viruses ( 16 ), it is unclear whether SARS-CoV-2 can directly affect the pancreas or the pancreas is involved as part of the virus-triggered systemic inflammatory response and cytokine storm leading to multiorgan dysfunction ( 14 , 17 ). Furthermore, there is an abundance of data regarding nonpancreatic causes of lipase elevation in critically ill patients from etiologies such as pancreatic hypoperfusion from shock, mechanical ventilation, pulmonary disease, and renal failure ( 18 ), any of which can occur in COVID-19 ( 1 ).…”

Lipotoxicity and Cytokine Storm in Severe Acute Pancreatitis and COVID-19

“…Although most patients recover from acute pancreatitis, a significant number will progress to chronic pancreatitis. 6 By far the most common risk factors for acute pancreatitis are immoderate alcohol use 7 or gallstone disease. 8 How gallstones induce pancreatitis has long been a matter of debate.…”

“…3 An increasing number of publications have reported that SARS-CoV-2 targets the pancreas resulting in elevation of serum lipase activity or rarely even frank pancreatitis. [4][5][6][7] Autopsy data suggest that the incidence of focal pancreatitis in COVID-19 may be higher than diagnosed clinically. 8 However, it is conceivable that the virus targets not only the pancreas, but also adipocytes causing increased lipolysis through the adipose triglyceride lipase (Figure 1, A).…”

Anti-inflammatory drugs and the renin-angiotensin-aldosterone system: Current knowledge and potential effects on early SARS-CoV-2 infection

“…This possibly makes the pancreas, by virtue of ACE2-dependent viral entry, one of the major targets of SARS-CoV-2. Complications may include acute pancreatitis resulting from direct injury to pancreatic acinar cells or uncontrollable systemic inflammatory response from cytokine storm syndrome, both of which have been documented in the disease ( Thaweerat, 2020 ). Acute pancreatitis due to SARS-CoV-2 infection could pose an additional threat to people afflicted with diabetes mellitus (DM) types 1 and 2 by promoting metabolic complications as the infection continues to alter pancreatic β-cell function, which may in fact explain the feared risks of severe COVID-19 among patients with DM ( Apicella et al, 2020 ).…”